Abstract: Tension-type headache (TTH) represents the most prevalent primary headache disorder, distinguished by its bilateral, pressing, or tightening pain quality, lacking the pronounced features of migraine or cluster headaches. This article aims to delineate the differential diagnosis of TTH, underlining the importance of clinical evaluation in distinguishing it from other headache syndromes.
Introduction: TTH, characterized by its non-pulsatile, mild to moderate intensity, poses a diagnostic challenge due to its symptom overlap with other headache disorders. Accurate diagnosis is pivotal, as it informs therapeutic strategies and prognosis.
Etiopathogenesis: The pathophysiology of TTH is not fully understood, but it is thought to involve a combination of muscle tension, stress, and neurovascular factors. Unlike migraines, TTH does not typically feature an aura or significant autonomic symptoms.
Clinical Presentation: TTH is typified by a bilateral, band-like pain around the head, often described as a tight grip in a ‘hatband’ distribution. It lacks the throbbing quality of migraines and is not typically exacerbated by routine physical activity.
Differential Diagnosis:
- Migraine: Key distinguishing factors include unilateral, pulsating pain, and accompanying symptoms like photophobia, phonophobia, nausea, or vomiting.
- Cluster Headache: Intensely painful, unilateral headaches with autonomic symptoms like lacrimation or rhinorrhea, and a cyclical pattern.
- Medication-Overuse Headache: History of chronic analgesic use can lead to headache patterns mimicking TTH.
- Secondary Headaches: Headaches secondary to sinusitis, temporomandibular joint disorders, or cervical spine pathology can present similarly to TTH.
- Giant Cell Arteritis: In patients over 50, this should be considered, especially if the headache is new, with systemic symptoms or elevated inflammatory markers.
- Intracranial Hypertension: Headaches mimicking TTH with associated visual disturbances or evidence of papilledema.
Diagnostic Approach: A detailed clinical history and physical examination are crucial. Neuroimaging and laboratory tests are reserved for atypical cases or when secondary causes are suspected.
Management: Treatment is primarily non-pharmacological, focusing on lifestyle modification, stress management, and physical therapy. Pharmacotherapy is adjunctive, typically involving simple analgesics or non-steroidal anti-inflammatory drugs (NSAIDs).
Conclusion: TTH, while common, requires careful differentiation from other headache disorders. A thorough clinical assessment remains the cornerstone of diagnosis, guiding effective management strategies.
