Comment:
The following alternative criteria may be applied to A2.1 Infrequent episodic tension-type headache, A2.2 Frequent episodic tension-type headache and A2.3 Chronic tension-type headache. They define a core syndrome of tension-type headache. In other words these criteria are very specific but have low sensitivity.
Diagnostic criteria:
- Episodes, or headache, fulfilling criterion A for [whichever of 2.1 Infrequent episodic tension-type headache, 2.2 Frequent episodic tension-type headache or 2.3 Chronic tension-type headache] and criteria B-D below
- Headache lasting from 30 minutes to 7 days
- At least three of the following pain characteristics:
- bilateral location
- pressing/tightening (non-pulsating) quality
- mild or moderate intensity
- not aggravated by routine physical activity such as walking or climbing stairs
- No nausea (anorexia may occur), vomiting, photophobia or phonophobia
- Not attributed to other disorder1;2
Notes:
- History and physical and neurological examinations do not suggest any of the disorders listed in groups 5-12, or history and/or physical and/or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but headache does not occur for the first time in close temporal relation to the disorder.
- In the case of A2.3 Chronic tension-type headache and when medication overuse is present and fulfils criterion B for any of the subforms of 8.2 Medication-overuse headache, it is uncertain whether this criterion E is fulfilled until 2 months after medication has been withdrawn without improvement (see Comment).
Comment:
In many uncertain cases of chronic tension-type headache there is overuse of medication. When this fulfils criterion B for any of the subforms of 8.2 Medication-overuse headache, the default rule is to code for 2.4.3 Probable chronic tension-type headache plus 8.2.8 Probable medication-overuse headache. When these criteria A-E are still fulfilled 2 months after medication overuse has ceased, A2.3 Chronic tension-type headache should be diagnosed and 8.2.8 Probable medication-overuse headache must be discarded. Alternatively, if at any time sooner they are no longer fulfilled because improvement has followed withdrawal, 8.2 Medication-overuse headache should be diagnosed and 2.4.3 Probable chronic tension-type headache must be discarded.
