Currently Viewing:
Currently Reading
Study Suggests Tension Headaches Overdiagnosed in the Emergency Department
March 22, 2020 – Alison Rodriguez
Family History of Migraine Linked to Earlier Age of Onset, Study Says
March 14, 2020 – Alison Rodriguez
Report Finds Natural Clusters of Chronic Migraine Phenotypes
March 10, 2020 – Gianna Melillo
Review Assesses Role of Vitamin D in Migraine Mechanism, Treatment
March 07, 2020 – Gianna Melillo
Chocolate Lover? Review Finds No Definitive Proof It Triggers Your Migraines
March 04, 2020 – Gianna Melillo
Review Outlines Relationship Between Gut-Brain Axis, Migraine
February 24, 2020 – Gianna Melillo
Study Suggests 5 Stroke Risk Factors for Those With Migraine, Aura
February 22, 2020 – Alison Rodriguez
Migraineurs Exhibit Unique Sensory Responses to Stimuli
February 18, 2020 – Gianna Melillo
Evidence Links Migraine and Visual Cortex Abnormalities
February 12, 2020 – Gianna Melillo

Study Suggests Tension Headaches Overdiagnosed in the Emergency Department

Alison Rodriguez
Patients were reclassified as having other types of headaches.
A study evaluating the use of the International Classification of Headache Disorders (ICHD) criteria for tension-type headache (TTH) in the emergency department (ED) found that TTH was overdiagnosed and only a minority of patients fulfilled the ICHD criteria.

The research, published by Scientific Reports, involved an analysis of all ED patients with a definite TTH diagnosis in their discharge report for 2.5 years. The researchers determined whether the ICHD criteria for TTH were reference and met for each patient and they analyzed discrepancies concerning anamnesis or prior history and reclassified patients.

“Tension-type headache (TTH) is the most common primary headache disorder. The prevalence of TTH is estimated to be between 30 and 70% of the general population according to different studies,” the authors said. “The diagnostic criteria proposed by the International Classification of Headache Disorders (ICHD) have remained unaltered since the first edition in 1988. The criteria are based on bilateral, oppressive and mild pain, without typical migraine features and with no better explanation.”

The results revealed that only 211 out of 2132 patients had fulfilled the criteria (9.9%). Furthermore, only 5 patients had fulfilled the TTH criteria. The researchers explained that criteria A-D were referenced in 60% to 84% of patients and met in 16% to 74% of those patients. Additionally, anamnesis was discrepant in 87.5%, while prior history was discrepant in 20.8%.

“In our sample, TTH was overdiagnosed in an emergency department, as only 2.4% of the patients fulfilled all ICHD criteria for TTH. Inconsistencies in prior medical history or anamnesis were present in the discharge reports in one-fifth and four-fifths of patients, respectively. Our analysis of medical records allowed us to reclassify these patients as having other primary or secondary headaches,” the authors concluded. “Efforts to improve knowledge on headache disorders and ICHD are needed among ED physicians.”

Overall, the researchers concluded that in the study sample, TTH was over diagnosed and only a minority of patients had fulfilled the ICHD criteria; however, the authors emphasized that inconsistencies in prior history or anamnesis were frequent.


Garcia-Azorin D, Farid-Zahran M, et al. Tension-type headache in the emergency department diagnosis and misdiagnosis: The TEDDi study [published online February 12, 2020]. Scientific Reports. doi: 10.1038/s41598-020-59171-4.

Copyright AJMC 2006-2020 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up