Synopsis
Diagnose tension-type headache from a bilateral, non-disabling pressure phenotype, distinguish frequent and chronic patterns from migraine or secondary disease, and manage pain without driving medication overuse.
- Typical tension-type headache is bilateral, pressing or tightening, mild to moderate and not aggravated by ordinary activity such as walking or climbing stairs.
- Nausea or vomiting argues against tension-type headache; either photophobia or phonophobia may occur, but both together support migraine more strongly.
- Attacks can last from 30 minutes to days, and the diagnosis is positive when the recurrent phenotype fits and examination reveals no secondary concern.
Key red flags
Thunderclap onset, systemic illness, positional provocation, focal signs, papilloedema or progressive personality and cognitive change is incompatible with uncomplicated tension-type headache.
Investigation priorities
Differentiate tension-type headache from migraine and identify an onset or associated feature suggesting secondary disease.
Management branches
A person describes recurrent non-disabling headache without obvious emergency features.
- Characterise onset, duration, frequency, quality, laterality, activity effect, nausea, sensory sensitivity and medication use, comparing separate attack types when necessary.
- Check systemic and neurological red flags, blood pressure and a targeted examination including optic discs when feasible.
Key medicines
ParacetamolUsually 1 g orally when required for an adult at least 50 kg, with at least 4–6 hours between doses and maximum 4 g daily.
IbuprofenA common adult non-prescription dose is 400 mg orally when required, following licensed intervals, duration and the local daily maximum.