Neurology
AKT · Neurology/Headache & facial painlow yield
Tension-type headache
Primary headache — the commonest type
Overview
The commonest primary headache: bilateral, mild–moderate, pressing/tightening "band around the head", without the nausea, aura or activity-aggravation of migraine. Often related to stress, fatigue and poor posture.
Recognise
- Bilateral, pressing/tight "band" around the head, mild–moderate
- NOT pulsatile, NOT worsened by routine activity, no significant nausea/vomiting or aura
- Episodic or chronic (≥15 days/month); stress/fatigue/dehydration triggers
Red flags
- New pattern, red-flag features (see panel) → exclude secondary causes; medication-overuse if frequent analgesia
Differentials & how to tell them apart
Migraineunilateral, pulsatile, nausea/photophobia, worse with activity, ± aura
Medication-overuse headachefrequent analgesic use, rebound headache
Idiopathic intracranial hypertensionpapilloedema, visual symptoms, worse lying down
Investigations
Clinical diagnosis; no imaging unless red flags.
Management
Simple analgesia for acute attacks; address triggers; amitriptyline if frequent
- 1Reassure; simple analgesia (paracetamol/NSAID) for episodic attacks; address stress, posture, dehydration, sleep.Gate: Limit acute analgesic use to <10–15 days/month to avoid converting it into a medication-overuse headache
- 2Frequent/chronic: consider a course of amitriptyline; avoid routine opioids/codeine.
Simple analgesia (paracetamol, NSAID/aspirin) — acute; limit frequency to avoid medication-overuse
Amitriptyline — consider for frequent/chronic tension-type headache
Key points
The mirror image of migraine: bilateral, non-pulsatile, no nausea, not worsened by activity. The main trap is medication-overuse from over-treating it.
Monitor & prognosis
Frequency, analgesic use, trigger control.
Benign; chronic forms can be disabling but respond to amitriptyline + trigger management.
Source: NICE CKS; NICE NG (headaches)