Which headache type is characterized by a chronic daily pattern, bilateral distribution, and absence of autonomic or neurovegetative symptoms?

Explanation

## Tension-Type Headache: Defining Characteristics **Key Point:** Tension-type headache (TTH) is the **most common primary headache disorder** and is defined by its **bilateral, non-pulsatile quality**, **absence of autonomic features**, and **lack of associated neurovegetative symptoms**. ### Diagnostic Criteria for Chronic Tension-Type Headache According to ICHD-3 (International Classification of Headache Disorders), chronic TTH requires: 1. **Frequency:** ≥15 days per month for ≥3 months 2. **Duration:** 30 minutes to 7 days per episode 3. **Location:** Bilateral (often described as band-like, pressing, or tightening) 4. **Quality:** Non-pulsatile (pressing, tightening, squeezing) 5. **Severity:** Mild to moderate (does not prevent activity) 6. **Associated symptoms:** **Absent** — no nausea, no vomiting, no photophobia, no phonophobia, no autonomic symptoms **High-Yield:** The **absence of associated symptoms** is the defining negative criterion that distinguishes TTH from migraine and cluster headache. ### Comparison Table: Daily Headache Patterns | Feature | Chronic TTH | Chronic Migraine | Medication Overuse | | --- | --- | --- | --- | | **Frequency** | ≥15 days/month | ≥15 days/month | ≥15 days/month | | **Location** | Bilateral, band-like | Unilateral or bilateral | Variable | | **Quality** | Pressing, tightening | Throbbing, pulsatile | Variable | | **Associated symptoms** | None | Nausea, photophobia, phonophobia | Nausea, photophobia | | **Autonomic symptoms** | Absent | Absent | Absent | | **Trigger: medication use** | No | No | **Yes — ≥10–15 days/month** | | **Response to NSAIDs** | Variable | Good | Paradoxical worsening | **Clinical Pearl:** Patients with chronic TTH often report **stress, muscle tension in neck/shoulders, and poor posture** as triggers. The headache is typically **not disabling** — patients can continue daily activities, unlike migraine. ### Mnemonic **TTH = Tension + Tightening (bilateral) + No associated symptoms (No nausea, No autonomic) + Tension-related triggers** **Warning:** Do not confuse chronic TTH with chronic migraine. Chronic migraine **retains migraine features** (unilateral tendency, throbbing quality, nausea, photophobia) even when frequency increases to ≥15 days/month. TTH is defined by the **absence** of these features.