Headache, Tension-type

Constant daily headaches that are often vise-like or tight in quality but not pulsatile

May be exacerbated by emotional stress, fatigue, noise, or glare

Patients also frequently complain of pericranial tenderness, poor concentration and other nonspecific symptoms

Usually generalized

May be most intense about the neck or back of the head

Not associated with focal neurologic symptoms

Diagnosis is made after exclusion of other causes of headache (see individual diagnoses, eg, Sinusitis, Acute)

Therapeutic approach similar to that of migraine, except triptans and ergotamines are not indicated (see Headache, Migraine)

Tricylcic antidepressants such as amitriptyline are supported for headache prophylaxis by randomized trial evidence and often are tried first

Behavioral therapies that may be effective include biofeedback and relaxation training

Treatment of comorbid anxiety or depression