Taking care of the challenging tension headache patient.

Tension type headache (TTH) is the most common primary headache disorder, but it is a diagnosis for which patients infrequently present for evaluation in the outpatient setting. Performing a thorough evaluation and establishing the correct diagnosis is essential in formulating an effective treatment plan. There are many complex issues that, although not causative, may play an exacerbating role in TTH. This article reviews the epidemiology, diagnosis, and pharmacologic treatment of TTH. In addition, nonpharmacologic treatment approaches, sleep dysfunction, and temporomandibular dysfunction are reviewed.