Walsh & Hoyt: Tension-Type Headache

Tension-type headache (TTH) is the most common form of primary headache, with a lifetime prevalence ranging from 3078%. However, it remains the least studied of the primary headache syndromes, despite the fact that TTH may have the highest socioeconomic impact. Further, migraine headache is often misdiagnosed as TTH. In one study, 37% of patients originally diagnosed with TTH were later found to have migraine. The situation is complicated by the fact that migraine and TTH may coexist in the same patient. Indeed, the symptoms of each headache type may overlap. Muscle tension is often considered a unique feature of TTH, while migraine is commonly felt not to be associated with muscle tension or neck pain. Recent studies have suggested that neither of these assumptions may be correct. One study demonstrated that of 144 patients meeting IHS criteria for migraine, 75% described neck pain associated with the attacks. The second edition of the IHS criteria divides TTH into episodic and chronic forms. Episodic TTH is further subdivided into frequent and infrequent forms