Chronic tension-type headache differential diagnosis and treatment strategies

Abstract

Chronic tension-type headache (CTTH) is a primary headache disorder defined by headache occurring on ≥15 days per month for >3 months, typically bilateral, pressing/tightening, mild–moderate, and not worsened by routine physical activity. Because chronic daily headache has many possible causes, accurate diagnosis requires careful differentiation from chronic migraine, medication-overuse headache, and secondary headaches with red flags. Management is best approached with education and trigger/behavioral modification, evidence-based acute therapy avoiding opioids and minimizing frequent analgesic use, and preventive treatment—most consistently supported for amitriptyline—plus nonpharmacologic approaches such as exercise and psychological interventions when relevant.