Tension-type headache is diagnosed clinically, from a pressing or tightening pain affecting both sides, mild to moderate in intensity, not worsened by routine activity, and without significant nausea. It is defined largely by what it lacks. Frequency defines the subtype, and fifteen or more headache days a month for over three months makes it chronic rather than episodic.
Tension-type headache is diagnosed clinically, from a pressing or tightening pain affecting both sides, mild to moderate in intensity, not worsened by routine activity, and without significant nausea. It is defined largely by what it lacks. Frequency defines the subtype, and fifteen or more headache days a month for over three months makes it chronic rather than episodic.
The positive features are pressing or tightening quality rather than throbbing, bilateral location, mild to moderate intensity, and duration from thirty minutes to several days. Equally important is what is absent: it is not aggravated by ordinary activity such as walking upstairs, and it does not come with significant nausea or vomiting. At most one of light or sound sensitivity may be present. Those absences are what distinguish it from migraine.
Frequency defines the subtype. Infrequent episodic occurs on fewer than one day a month, frequent episodic on one to fourteen days a month, and chronic tension-type headache on fifteen or more days a month for over three months. The chronic form matters because it is considerably more disabling and, like chronic migraine, is frequently complicated by medication overuse, which needs identifying because continuing to escalate analgesics makes it worse.
Tension-type headache and migraine coexist in many people, and it is common for someone to have both, which complicates the history. Cervicogenic headache arising from the upper neck can mimic it. Medication overuse headache should be actively considered wherever frequency is high. Red flags prompting imaging include new headache after fifty, explosive onset, headache worse lying flat, fever with neck stiffness, or an abnormal examination; imaging is arranged externally.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: headache; American Academy of Neurology; National Institute of Neurological Disorders and Stroke.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.