Tension-Type Headache in Children and Adolescents

In pediatric neurology, tension-type headache (TTH) represents a very common type of primary headache during the pediatric age. Despite the high prevalence of TTH, this diagnosis is often underestimated in childhood, with relevant difficulties in the differential diagnosis of TTH from secondary and primary headache manifestations. Even among primary headaches, a clinical overlap is not so infrequent in children: migraine attacks could present tension headache-like features while tension-type headaches may display migraine-like symptoms as well. Several variables play a role in the complex trajectory of headache evolution, such as hormonal changes during adolescence, triggers and genetic and epigenetic factors. The trajectories and outcomes of juvenile migraine and TTH, as well as the transition of one form to the other, have been investigated in several long-term prospective studies. Thus, the aim of this paper is to review the current literature on the differential diagnosis workout of TTH in pediatrics, the possible outcomes during the developmental age and the appropriate therapeutic strategies. Indeed, TTH represents a challenging diagnostic entity in pediatrics, both from a clinical and a therapeutic point of view, in which early diagnosis and appropriate treatment are recommended.

Automated summary

In pediatric neurology, tension-type headache (TTH) is a common primary headache among children. However, it is often underestimated and difficult to differentiate from secondary and other primary headaches in childhood. There can be clinical overlap between migraine and TTH in children, with migraine attacks presenting tension headache-like features and TTH displaying migraine-like symptoms. Factors such as hormonal changes, triggers, and genetic and epigenetic factors play a role in the complex trajectory of headache evolution. This review aims to summarize the literature on the differential diagnosis of TTH in pediatrics, the possible outcomes during development, and appropriate therapeutic strategies.