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2.2 Frequent episodic tension-type headache


Frequent episodes of headache, typically bilateral, pressing or tightening in quality and of mild to moderate intensity, lasting minutes to days. The pain does not worsen with routine physical activity and is not associated with nausea, although photophobia or phonophobia may be present.

Diagnostic criteria:
  1. At least 10 episodes of headache occurring on 1-14 days/month on average for >3 months (≥12 and <180 days/year) and fulfilling criteria B-D
  2. Lasting from 30 minutes to 7 days
  3. At least two of the following four characteristics:
    1. bilateral location
    2. pressing or tightening (non-pulsating) quality
    3. mild or moderate intensity
    4. not aggravated by routine physical activity such as walking or climbing stairs
  4. Both of the following:
    1. no nausea or vomiting
    2. no more than one of photophobia or phonophobia
  5. Not better accounted for by another ICHD-3 diagnosis1.

When headache fulfils criteria for both 1.5 Probable migraine and 2.2 Frequent episodic tension-type headache, code as 2.2 Frequent episodic tension-type headache (or as either subtype of it for which the criteria are fulfilled) under the general rule that definite diagnoses always trump probable diagnoses.


2.2 Frequent episodic tension-type headache often coexists with 1.1 Migraine without aura. Both disorders need to be identified, preferably through use of a diagnostic headache diary, because the treatments of each differ considerably. It is important to educate patients to distinguish between these headache types if they are to select the right treatment for each while avoiding medication overuse and its adverse consequence of 8.2 Medication-overuse headache.