# Tension-Type Headache and Chronic Daily Headache > Tension-type headache and chronic daily headache for NEET-PG Medicine covers diagnostic criteria, migraine differences and preventive options. - Canonical URL: https://prepelephant.com/topics/neet-pg/medicine/tension-type-headache-and-chronic-daily-headache - Exam / course: NEET-PG · Subject: Medicine - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-14 - Last updated: 2026-10-14 - Reference basis: Harrison's Principles of Internal Medicine; Adams and Victor's Principles of Neurology - How to cite: "Tension-Type Headache and Chronic Daily Headache", PrepElephant, https://prepelephant.com/topics/neet-pg/medicine/tension-type-headache-and-chronic-daily-headache ## Direct answer Tension-type headache is the most common primary headache, causing bilateral, pressing or tightening pain of mild to moderate intensity without nausea or vomiting. It is episodic when it occurs on fewer than 15 days a month, and chronic when it occurs on 15 or more days a month for over three months. The diagnosis is clinical and rests on the absence of nausea and pulsatile pain. ## What you must remember - **Commonest headache:** tension-type headache is the most frequent primary headache, and most people experience it at some point. - **Episodic versus chronic:** fewer than 15 headache days a month is episodic, while 15 or more days a month for over three months defines chronic tension-type headache. - **Character:** bilateral, pressing or tightening, mild to moderate, and not worsened by routine physical activity. - **Associated features:** no vomiting and no moderate or severe nausea (mild nausea is allowed only in the chronic form), with at most one of photophobia or phonophobia. - **Migraine differences:** migraine is often unilateral and pulsating, moderate to severe, worsened by activity and accompanied by nausea and sensory sensitivity. - **Medication overuse:** simple analgesics on 15 or more days a month, or triptans, opioids and combination analgesics on 10 or more days, can perpetuate chronic headache. - **Preventive option:** low-dose amitriptyline is the best-supported preventive for frequent or chronic episodes. - **Red flags:** sudden onset, progression, a new pattern after age 50, focal signs or papilloedema demand investigation before the diagnosis is accepted. ## A stepwise approach to a daily headache A 38-year-old teacher has a band-like headache on most days for eight months, with no vomiting and a normal neurological examination. The pattern suggests a primary headache, but analgesic use and red flags still need checking. The steps below move from classification to prevention. 1. **Count the days:** Record headache days per month and total duration to separate episodic from chronic tension-type headache. 2. **Characterise the pain:** Confirm bilateral, pressing, mild to moderate pain that is not aggravated by routine activity and is not accompanied by nausea. 3. **Screen for red flags:** Sudden onset, progressive pattern, new onset after age 50, focal deficits or papilloedema need imaging or review before a primary diagnosis. 4. **Review analgesic use:** Count days of simple analgesics, triptans and opioids, because overuse can drive chronicity. 5. **Address lifestyle factors:** Sleep, caffeine, stress, screen time and neck or jaw posture are commonly associated with tension headache, though the link is often modest. 6. **Start prevention:** Low-dose amitriptyline, usually taken at night, is the first choice for frequent or chronic episodes, with relaxation training and cognitive behavioural therapy used alongside. ## Where the exam tries to catch you The usual errors come from calling every bilateral headache tension-type or from treating chronic pain with repeated acute drugs. - **Trap:** labelling every bilateral headache as tension-type — **Correct:** nausea, photophobia or a pulsatile quality points to migraine, and red flags always need proper assessment. - **Trap:** treating chronic daily headache with more triptans or opioids — **Correct:** overuse of acute drugs is a common cause of chronicity, so limit them and start prevention. - **Trap:** choosing a migraine preventive as the default for tension-type headache — **Correct:** amitriptyline has the best support here, whereas beta-blockers are used mainly for migraine. ## Frequently asked questions ### How does tension-type headache differ from migraine? Tension-type headache is usually bilateral, pressing and mild to moderate, without nausea, and it is not worsened by routine activity. Migraine is typically unilateral or pulsating, moderate to severe, and accompanied by nausea or photophobia and phonophobia. Worsening with physical activity helps separate migraine from tension-type headache. ### What defines chronic tension-type headache? Chronic tension-type headache is defined by headache on 15 or more days a month for more than three months, with the features of tension-type headache. The distinction matters because chronic headache requires a review of analgesic use. It also needs preventive treatment rather than repeated acute medication. ### Which drug is the most useful preventive for chronic tension-type headache? Low-dose amitriptyline is the best-supported preventive for chronic tension-type headache, usually taken at night. It is combined with non-drug measures such as relaxation training and cognitive behavioural therapy where available. Analgesic overuse must be addressed alongside any preventive drug. ### When does a headache need investigation rather than a tension-type diagnosis? A headache needs investigation when red flags are present, such as sudden onset, a progressive pattern, new onset after age 50, focal neurological signs or papilloedema. Imaging is considered in these patients before a primary headache diagnosis is accepted. Tension-type headache is a diagnosis made only after red flags have been excluded. ### How many analgesic days cause medication overuse headache? Medication overuse headache is defined by simple analgesics on 15 or more days a month, or triptans, opioids and combination analgesics on 10 or more days a month, for over three months. Headache on these days is driven by repeated drug use rather than the original disorder. Withdrawing the overused drug and starting prevention is the usual approach.