| IHS | Diagnosis | ICD-10 |
|---|---|---|
| 2.1.1 | Infrequent episodic tension-type headache associated with pericranial tenderness | G44.20 |
Diagnostic criteria:
- Episodes fulfilling criteria A-E for 2.1 Infrequent episodic tension-type headache
- Increased pericranial tenderness on manual palpation
Comments:
Increased pericranial tenderness recorded by manual palpation is the most significant abnormal finding in patients with tension-type headache. The tenderness increases with the intensity and frequency of headache and is further increased during actual headache. The diagnostic value of EMG and pressure algometry is limited and these recordings are therefore omitted from the second edition. Pericranial tenderness is easily recorded by manual palpation by small rotating movements and a firm pressure (preferably aided by use of a palpometer) with the second and third finger on the frontal, temporal, masseter, pterygoid, sternocleidomastoid, splenius and trapezius muscles. A local tenderness score from 0-3 on each muscle can be summated to yield a total tenderness score for each individual. It has been demonstrated that, using a pressure sensitive device that allows palpation with a controlled pressure, this clinical examination becomes more valid and reproducible. However, such equipment is not generally available to clinicians and it is advised that clinicians simply perform the manual palpation as a traditional clinical examination.
Palpation is a useful guide for the treatment strategy. It also adds value and credibility to the explanations given to the patient.
