Study Suggests Tension Headaches Overdiagnosed in the Emergency Department

March 22, 2020

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.