Diagnosis of Tension-Type Headache: Clinical Features, Trigger Factors, and Migraine Differentiation
Dear colleagues, tension-type headache (TTH) is one of the most common forms of primary headache, characterized by a bilateral and pressing headache. Despite its high prevalence, the diagnosis of tension-type headache can be challenging due to symptom overlap with other headaches, such as migraine. In this article, we will explore the clinical features and trigger factors of TTH, providing a guide for its diagnosis and management.
Clinical Features of Tension-Type Headache
Tension-type headache typically presents as a bilateral headache, with mild to moderate intensity, that does not worsen with physical activity. Unlike migraine, TTH is not usually accompanied by nausea or vomiting, although there may be slight light or noise sensitivity. Muscle tension in the neck and shoulders is a common finding in these patients, and it has been observed that myofascial trigger points can reproduce headache pain in children and adults with chronic TTH [1].
In the pediatric population, TTH is also prevalent and can be confused with migraine due to overlapping symptoms. However, studies have shown that the International Headache Society criteria can be adapted for diagnosis in children, highlighting the importance of a detailed clinical evaluation [2].
Trigger Factors and Management
Stress management is crucial in the treatment of tension-type headache, as emotional and physical stress are common triggers. Identifying these factors is essential for effective management of TTH. A recent study in Japan highlighted that fatigue and weather changes are frequent triggers of TTH, underscoring the need for personalized management strategies [3].
Furthermore, differentiation between tension-type headache and migraine is fundamental for appropriate treatment. Although both conditions can coexist, migraine is distinguished by symptoms such as nausea and photophobia, which are not characteristic of TTH. The differentiation between migraine and tension-type headache is essential to avoid inappropriate treatments and improve patient quality of life [4].
Conclusions
The diagnosis of tension-type headache requires careful clinical evaluation to differentiate it from other primary headaches, such as migraine. Identifying specific clinical features and trigger factors is key to effective management. Educating patients about stress management and identifying personal triggers can significantly improve treatment outcomes. As physicians, it is our responsibility to be attentive to these differences to provide the best possible care for our patients.
Referencias
[2] Tension-Type Headache in Children and Adolescents.
[4] Debate: differences and similarities between tension-type headache and migraine.
Created 5/1/2025