How Tension-Type Headache Presents

  • Lars Bendtsen
  • Rigmor Jensen
  • Elizabeth W. Loder
Reference work entry


The substantial societal and individual burdens associated with tension-type headache (TTH) constitute a major public health issue that has previously been overlooked. Tension-type headache is extremely prevalent, affecting up to 78% of the general population; roughly 3% suffer from chronic tension-type headache. Tension-type headache is the most featureless of headaches. An accurate diagnosis, in which the individual headache episode is distinguished from migraine and from a secondary headache, especially medication overuse headache, is essential. The use of a diagnostic headache diary is helpful for treatment planning. Possible triggers and comorbidity with other disorders, in particular depression, should also be assessed before treatment is initiated.


International Headache Society Medication Overuse Migraine Without Aura Secondary Headache Medication Overuse Headache 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Andlin-Sobocki P, Jonsson B, Wittchen HU, Olesen J (2005) Cost of disorders of the brain in Europe. Eur J Neurol 12(Suppl 1):1–27PubMedCrossRefGoogle Scholar
  2. Bendtsen L (2000) Central sensitization in tension-type headache – possible pathophysiological mechanisms. Cephalalgia 20:486–508PubMedCrossRefGoogle Scholar
  3. Bendtsen L, Jensen R (2006) Tension-type headache: the most common, but also the most neglected, headache disorder. Curr Opin Neurol 19:305–309PubMedGoogle Scholar
  4. Bendtsen L, Jensen R, Jensen NK, Olesen J (1995) Pressure-controlled palpation: a new technique which increases the reliability of manual palpation. Cephalalgia 15:205–210PubMedCrossRefGoogle Scholar
  5. Berg J, Stovner LJ (2005) Cost of migraine and other headaches in Europe. Eur J Neurol 12(Suppl 1):59–62PubMedCrossRefGoogle Scholar
  6. Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders: 2nd edition. Cephalalgia 24(suppl 1):1–160Google Scholar
  7. Holroyd KA, Stensland M, Lipchik GL, Hill KR, O'Donnell FS, Cordingley G (2000) Psychosocial correlates and impact of chronic tension-type headaches. Headache 40:3–16PubMedCrossRefGoogle Scholar
  8. Jensen R (1999) Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies. Cephalalgia 19:602–621PubMedCrossRefGoogle Scholar
  9. Jensen R, Stovner LJ (2008) Epidemiology and comorbidity of headache. Lancet Neurol 7:354–361PubMedCrossRefGoogle Scholar
  10. Jensen R, Symon D (2005) Epidemiology of tension-type headaches. In: Olesen J, Goadsby PJ, Ramadan N, Tfelt-Hansen P, Welch KM (eds) The headaches. Lippincott, Williams & Wilkins, Philadelphia, pp 621–624Google Scholar
  11. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R (2005a) Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. Eur J Epidemiol 20:243–249PubMedCrossRefGoogle Scholar
  12. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R (2005b) Incidence of primary headache: a Danish epidemiologic follow-up study. Am J Epidemiol 161:1066–1073PubMedCrossRefGoogle Scholar
  13. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R (2005c) Prognosis of migraine and tension-type headache: a population-based follow-up study. Neurology 65:580–585PubMedCrossRefGoogle Scholar
  14. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R (2005d) Secular changes in health care utilization and work absence for migraine and tension-type headache: a population based study. Eur J Epidemiol 20:1007–1014PubMedCrossRefGoogle Scholar
  15. Rasmussen BK (1995) Epidemiology of headache. Cephalalgia 15:45–68PubMedGoogle Scholar
  16. Rasmussen BK, Jensen R, Olesen J (1991a) A population-based analysis of the diagnostic criteria of the International Headache Society. Cephalalgia 11:129–134PubMedCrossRefGoogle Scholar
  17. Rasmussen BK, Jensen R, Schroll M, Olesen J (1991b) Epidemiology of headache in a general population – a prevalence study. J Clin Epidemiol 44:1147–1157PubMedCrossRefGoogle Scholar
  18. Rasmussen BK, Jensen R, Olesen J (1992) Impact of headache on sickness absence and utilisation of medical services: a Danish population study. J Epidemiol Commun Health 46:443–446CrossRefGoogle Scholar
  19. Russell MB, Rasmussen BK, Brennum J, Iversen HK, Jensen R, Olesen J (1992) Presentation of a new instrument: the diagnostic headache diary. Cephalalgia 12:369–374PubMedCrossRefGoogle Scholar
  20. Schwartz BS, Stewart WF, Lipton RB (1997) Lost workdays and decreased work effectiveness associated with headache in the workplace. J Occup Environ Med 39:320–327PubMedCrossRefGoogle Scholar
  21. Stovner L, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, Steiner T, Zwart JA (2007) The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 27:193–210PubMedCrossRefGoogle Scholar
  22. Tassorelli C, Sances G, Allena M, Ghiotto N, Bendtsen L, Olesen J, Nappi G, Jensen R (2008) The usefulness and applicability of a basic headache diary before first consultation: results of a pilot study conducted in two centres. Cephalalgia 28:1023–1030PubMedCrossRefGoogle Scholar

Copyright information

© Lifting The Burden 2011

Authors and Affiliations

  • Lars Bendtsen
    • 1
  • Rigmor Jensen
    • 1
  • Elizabeth W. Loder
    • 2
  1. 1.Danish Headache Centre and Department of NeurologyGlostrup Hospital, University of CopenhagenGlostrupDenmark
  2. 2.Division of Headache and Pain, Department of NeurologyBrigham and Women’s/Faulkner HospitalsBostonUSA

Personalised recommendations