2.2 Frequent episodic tension-type headache

Description:
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, but photophobia or phonophobia may be present.

Diagnostic criteria:
A. At least 10 episodes of headache occurring on 1-14 days per month on average for >3 months (≥12 and <180 days per year) and fulfilling criteria B-D
B. Lasting from 30 min to 7 days
C. 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

D. Both of the following:

    1. no nausea or vomiting
    2. no more than one of photophobia or phonophobia

E. Not better accounted for by another ICHD-3 diagnosis.

Comments:
2.2 Frequent episodic tension-type headache often coexists with 1.1 Migraine without aura. Coexisting tension-type headache in migraineurs should preferably be identified through use of a diagnostic headache diary. The treatment of migraine differs considerably from that of tension-type headache, and it is important to educate patients to distinguish between these headache types if they are to select the right treatment for each whilst avoiding medication overuse and its adverse consequence of 8.2 Medication-overuse headache.

When headache fulfils criteria for both 1.5 Probable migraine and 2. Tension-type headache, code as 2. Tension-type headache (or as any subtype of it for which the criteria are fulfilled) under the general rule that definite diagnoses always trump probable diagnoses. When headache fulfils criteria for both 1.5 Probable migraine and 2.4 Probable tension-type headache, code as the former under the general rule of hierarchy, which puts 1. Migraine and its subtypes before 2. Tension-type headache and its subtypes.