Table 2-5 Tension-type headache

2.1 Episodic tension-type headache (ETTH)

Diagnostic criteria

A. At least 10 previous headache episodes fulfilling criteria B-D. Number of days with such headache <180/year (<15/month)

B. Headache lasting from 30 minutes to 7 days

C. At least 2 of the following pain characteristics:

  1. Pressing/tightening (nonpulsating) quality

  2. Mild or moderate intensity (may inhibit but does not prohibit activities)

  3. Bilateral location

  4. No aggravation by walking stairs or similar routine physical activity

D. Both of the following:

  1. No nausea or vomiting (anorexia may occur)

  2. Photophobia and phonophobia are absent, or one but not the other is present

E. No evidence of organic disease

2.1.1 ETTH associated with disorder of pericranial muscles

Diagnostic criteria

A. Fulfills criteria for ETTH

B. At least one of the following:

  1. Increased tenderness of pericranial muscles demonstrated by manual palpation of pressure algometer

  2. Increased EMG level of pericranial muscles at rest or during physiological tests

2.1.2 ETTH unassociated with disorder of pericranial muscles

Diagnostic criteria

A. Fulfills critria for ETTH

B. No increased tenderness of pericranial muscles; if studied, EMG of pericranial muscles shows normal levels of activity

2.1.3 Chronic tension-type headache

Diagnostic criteria

A. Average headache frequency 15 days/month (180 days/year) for 6 months, fulfilling criteria B-D

B. At least 2 of the following pain characteristics:

  1. Pressing/tightening quality

  2. Mild or moderate severity (may inhibit but does not prohibit activities)

  3. Bilateral location

  4. No aggravation by walking stairs or similar routine physical activity

C. Both of the following:

  1. No vomiting

  2. No more than one of the following: nausea, photophobia, or phonophobia

D. No evidence of organic disease

2.2.1 Chronic tension-type headache associated with disorder of pericranial muscles

2.2.2 Chronic tension-type headache unassociated with disorder of pericranial muscles

Source: Headache Classification Committee of the International Headache Society (1988).

Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J.