Tension Type Headache Differential Diagnosis Table

Differential Diagnosis Tension-Type Headache Table:

Tension-type headache is one of the most common types of headaches. It is a neurological condition that causes mild to moderate headache, lasting for some minutes or for a longer duration. During an attack, one feels as if there is a band wrapped around their head, which is pressing and tightening, producing a dull pain. These headaches are broadly classified into two types on the basis of the frequency: episodic and chronic.

How To Distinguish Tension-Type Headache from Other Diseases

Distinguish Migraine from Tension-Type Headache – Diagnosis

Migraine is a neurological disorder that produces a headache on one side of the head with other associated symptoms like nausea, vomiting, photophobia, and phonophobia.

• The majority of migraine attacks are associated with gastrointestinal and sensory symptoms like nausea, vomiting, sensitivity to noise, and light. Tension-type headaches are not associated with these symptoms.
• Migraines are usually unilateral, only affecting one side of the head. Alternatively, tension-type headaches are always bilateral.
• Moreover, the nature of migraine pain is severe and throbbing as compared to the tension-type headache which produces mild and dull pain.

Distinguish Cluster Headache from Tension-Type Headache – Diagnosis

Cluster headache is another headache type that usually involves the ocular region and produces pain extremely severe in nature. They are frequently accompanied by other symptoms like lacrimation, redness of eyes, drooping eyelids, and nasal congestion.

• Cluster headaches can be differentiated from tension-type headaches on the basis of the severity of pain. The pain associated with cluster headaches is extremely severe in nature, while the tension-type headaches rarely cause severe pain.
• Cluster headaches are accompanied by other autonomic symptoms like lacrimation, nasal congestion, and aural fullness. These are very rare to find in tension-type headaches.
• Cluster headaches are always unilateral, unlike the tension-type headache, which can never be unilateral.

Distinguish Tumor-Related Headache from Tension-Type Headache – Diagnosis

Tumor-related headache or pain occurs when the tumor suppresses a vital structure like nerves or vessels. Headache occurring as a result of a tumor is very rare.

• Tumor-related headache can present with neurological symptoms like dizziness, confusion, slurred speech, seizures, disorientation, weakness, and paralysis. These are serious complications and can never occur along with tension-type headache.
• Moreover, they can also present with gastrointestinal issues like nausea and vomiting. These are very rare findings in tension-type headache.

Distinguish Hypertension from Tension-Type Headache – Diagnosis

Hypertension is a condition in which the systemic arterial pressure rises to or above 140/90 mmHg. Hypertension usually never causes headaches. However, an exception is hypertensive crisis in which the arterial pressure goes way above the normal value, reaching the value of around 180/120 mmHg.

• Hypertension headache is also bilateral like tension-type headaches. But both of them are different in the nature of the pain they produce. Literature suggests that hypertension is known to cause a pulsating headache, while the tension-type headache is felt as a dull pain.
• Hypertension headache is almost always present with high systolic and diastolic pressures. On the other hand, this is a rare finding with tension-type headaches.
• Moreover, the symptoms typical of hypertension, such as palpitations, nausea, dizziness, fatigue, breathlessness, and blurred vision, are not commonly present with tension-type headaches.

Distinguish Sinusitis from Tension-Type Headache – Diagnosis

Sinusitis, commonly known as a sinus infection, is an inflammation of the mucosal membrane of the paranasal sinuses, cavities surrounding the nasal cavity. It causes flu-like symptoms including headache, facial pain, fever, and a runny nose.

• The headache associated with sinusitis is usually accompanied by symptoms typical of sinusitis like fever, runny nose, and coughing. Tension-type headache is not associated with these symptoms.
• Some evidence suggests that sinusitis is associated with toothache, especially in the posterior maxillary teeth. Tension-type headache can never be associated with toothache.
• Furthermore, a very common finding with sinusitis is facial pain. The pain of the tension-type headache is always confined to the forehead, back of the head, and neck.

“On clinical examination, facial swelling can be appreciated, and the facial skin is tender upon palpation. Moreover, the patient usually gives a history of pain exacerbation upon positional changes like bending down.”

Distinguish Cervicogenic Headache from Tension-Type Headache – Diagnosis

Cervicogenic headache is a type of headache originating as a consequence of neck soft tissue or cervical spine irritation.

• Cervicogenic headaches are usually unilateral, while tension-type headaches are bilateral.
• Cervicogenic headaches usually cause neck stiffness, which results in limited neck movement. Although tension-type headache is associated with neck pain, it never causes neck stiffness.

Distinguish Temporomandibular Joint Disorder from Tension-Type Headache – Diagnosis

The temporomandibular joint connects the mandible and temporal bone at the base of the skull. Any condition that disrupts the normal functioning of this joint is known as temporomandibular joint disorder. Among other symptoms, headache is a common symptom and it can be easily confused with tension-type headache.

• Headache caused by temporomandibular joint disorder is a referred pain and is always accompanied by other symptoms like a clicking sound of the jaw, pain and tenderness in front of the ears, pain while chewing, and yawning. These symptoms are not common with tension-type headaches.
• It has been frequently observed that these patients usually have sensitivity in teeth due to bruxism. Tension-type headaches do not produce symptoms in the dentition.

Distinguish Trigeminal Neuralgia from Tension-Type Headache – Diagnosis

Trigeminal neuralgia is a neurological condition that produces short-lived electric shock-like pain on one side of the face.

• The pain is usually stimulated by something like brushing, shaving, and even touching the face. Tension-type headaches cannot be stimulated upon touching.
• Neuralgia pain is always excruciating, unilateral, and can occur anywhere on the face. While tension-type headaches cause dull and bilateral pain. Their pain is usually confined to the forehead, back of the head, and neck.
• Trigeminal neuralgia pain is short-lived, lasting only seconds to two minutes, while tension-type headaches produce pain for hours to even days.

Distinguish Giant Cell Arteritis from Tension-Type Headache – Diagnosis

Giant cell arteritis, also known as temporal arteritis, is an autoimmune disorder that refers to inflammation of the arteries of the head, especially the temple region.

• Temporal arteritis is unilateral while tension-type headache is always bilateral.
• It causes visual disturbances, and severe cases often result in blindness. Tension-type headaches never cause blindness.
• Another common symptom of giant cell arteritis is jaw claudication which results in painful mastication. However, pain during chewing is not common to tension-type headaches.

Distinguish Intracranial Disorders from Tension-Type Headache – Diagnosis

Intracranial disorders are disorders affecting the brain either due to injury or infection. This increases the intracranial pressure, which results in a headache and associated symptoms.

• These disorders are always associated with neurological symptoms like dizziness, slurred speech, fatigue, seizures, and memory loss. These symptoms can never occur due to tension-type headache.
• Other symptoms like nausea and vomiting, common with intracranial disorders, are rare to be encountered with tension-type headaches.

Important Red Flags in Tension-Type Headache

The headaches produced by all of the conditions mentioned above are somewhat similar. The chances of misdiagnosis are higher. It is critical to diagnose the condition correctly in the first place so that appropriate management can be provided. Migraines, tension-type headaches, and cluster headaches are all very similar and are often confused with each other. Tension-type headache among the three of them is the only bilateral headache. The other two are usually unilateral. Moreover, they are always accompanied by symptoms unique to them and should be considered while diagnosing.
Diagnosis of conditions like tumor-associated headaches, giant cell arteritis, and intracranial disorders is crucial to diagnose. Since they cause life-threatening and serious consequences. All these conditions produce neurological symptoms not common to tension-type headaches.