[The myth of tension-type headache]

Tension-type headache is an entity recognised by the International Headache Society in its International Headache Classification. The limits of this condition, however, are somewhat fuzzy and poorly defined, and its diagnostic criteria are a sort of negation of the symptoms of migraine. In this review we are especially interested in highlighting the diagnostic vagueness in patients with chronic tension-type headache. This refers, above all, to those with a clear history of migraine and who continue to suffer a number of crises with symptoms of migraine, although they have headaches with tension-type features on a daily basis. Emphasis will be placed on the novel concept of chronic migraine which, today, can include these patients, and has not only diagnostic but also, and above all, therapeutic implications. Tension-type headache is a clinical syndrome that probably covers a series of entities with important aetiopathogenic differences from one to another and, perhaps sometime in the future, many patients who are now labelled as having been diagnosed with this condition will be classified further as having other better-defined diseases. In any case, although it might sound like a myth or just pie-in-the-sky, the tension-type headache is still needed to encompass these entities that are lacking any better-defined diagnoses.