ABSTRACT
Tension-type headache (TTH) is the most prevalent primary headache (1) and is usually considered a ‘‘normal’’ headache type both by patients and their doctors. Furthermore, in specialized headache clinics, the vast majority of patients present with migraine or secondary headaches as their main problem and due to very little academic or pharmaceutical interest, less disabling headaches, such as TTH, are frequently missed. Nevertheless, TTH is a substantial problem in the general population and represents a major confounder in the diagnostic and therapeutic process of the complicated headache patient. In a comparative study by Russell et al. where headache diagnosis from a clinical interview was compared to the diagnosis from a prospective headache diary, less than 50% of the patients who reported episodic TTH during the clinical interview were actually identified. The opposite pattern was seen with migraine (2). Because very recent epidemiological data clearly demonstrate a poor prognosis and a very high socioeconomic impact in patients with coexisting migraine and TTH compared to that in patients with pure migraine, the correct diagnosis and the precise treatment of TTH are very important (3).
