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.
Title: El mito de la cefalea tensional.
La cefalea tensional es una entidad reconocida por la Sociedad Internacional de Cefaleas en su Clasificacion Internacional de Cefaleas. Sin embargo, los limites de dicha entidad quedan muy difusos y mal definidos en ella, y sus criterios diagnosticos son una suerte de negacion de los sintomas de la migraña. En la presente revision nos interesa especialmente resaltar la vaguedad diagnostica de los pacientes con cefalea tensional cronica. Sobre todo, de aquellos con antecedentes claros de migraña y que siguen sufriendo algunas crisis con sintomas migrañosos, aunque tengan cefalea de caracteristicas tensionales a diario. Haremos hincapie en el nuevo concepto de migraña cronica que, en la actualidad, permite acoger en su seno a estos pacientes, con implicaciones no solo diagnosticas, sino, sobre todo, terapeuticas. La cefalea tensional es probablemente un sindrome clinico que abarca una serie de entidades con grandes diferencias etiopatogenicas entre ellas y, quizas en un futuro, muchos pacientes que ahora son etiquetados con este diagnostico sean desgranados en distintas enfermedades mejor definidas. De todos modos, aunque suene a mito o entelequia, la cefalea tensional es aun necesaria para englobar a estas entidades huerfanas de diagnosticos mejor definidos.