Tension-type headache is one of the most common forms of headache among children and adolescents, alongside migraine. The prevalence of tension-type headache in this demographic is variable, with studies reporting a range from 0.9% to 73%, largely due to differing diagnostic criteria. The typical onset age is between 5 and 12 years.

These headaches are more frequently observed in females during adolescence. Unlike migraines, genetics play a less significant role in tension-type headaches. The exact pathophysiology remains unclear but may involve trigeminal nerve activation. Characteristically, tension-type headaches present as bilateral, dull, and pressure-like pain of variable intensity, sometimes accompanied by phonophobia, and can last from minutes to days.

The International Headache Society classifies tension-type headaches into three subtypes: episodic infrequent (less than one day per month), episodic frequent (1–14 days per month), and chronic (15 or more days per month). Diagnosis is primarily based on clinical history and a normal neurological examination, including vital signs and funduscopic assessment.

The differential diagnosis for tension-type headaches is broad and includes organic disorders such as infections, malformations, bleeds, and systemic conditions. Neuroimaging is generally of low diagnostic value in patients with typical headache history and normal neurological exams, but it is recommended in cases involving vomiting, history of trauma, seizures, or abnormal neurological findings.

Tension-type headaches, or medication overuse headaches, may progress to chronic daily headaches. Treatment for episodic tension-type headaches includes reassurance, stress reduction, psychological and cognitive behavioral therapies, and appropriate use of acute analgesics like nonsteroidal anti-inflammatory drugs (NSAIDs). For chronic tension-type headaches, additional prophylactic treatment may be necessary, such as the use of antidepressants.