Tension-Type Headache
Pericranial myofascial nociception, with central sensitisation in chronic disease, produces a bilateral pressing headache that is mild to moderate and not worsened by routine physical activity.
Definition
A primary headache diagnosed on the pattern alone. Attacks last 30 minutes to 7 days and show at least two of four features: bilateral location, pressing or tightening non-pulsating quality, mild or moderate intensity, and no aggravation by routine physical activity. Episodic disease occurs on fewer than 15 headache days per month, chronic disease on 15 or more days per month for more than 3 months.
First principles
Activity tolerance is the discriminator you use at the bedside
Migraine is aggravated by, or causes avoidance of, routine activities of daily living. Tension-type headache is not. So ask what the person actually does during an attack. Someone who stops work, lies down in the dark and vomits has migraine until proved otherwise. Disabling tension-type headache is rare, and most people carrying that label have migraine.
This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.