Abstract
BackgroundAccording to the third beta edition of the International Classification of Headache Disorder (ICHD-3 beta), the diagnostic criteria for tension-type headache (TTH) might lead to the inclusion of individuals with headaches showing migrainous features. To better define TTH, the alternative diagnostic criteria were proposed in the appendix of ICHD-3 beta. This study attempted to test the alternative criteria for diagnosis of TTH proposed in ICHD-3 beta in a population-based sample from Korea.MethodsWe selected participants from the Korean population aged 19–69 years using stratified random sampling and evaluated them by interview using a questionnaire designed to identify headache type, headache characteristics, and psychiatric comorbidities.ResultsOf the 2,762 participants, 586 (21.3%) were diagnosed as having TTH using the standard criteria. Among these, 238 (40.6%) were also classified as having TTH using the alternative criteria. All 238 TTH subjects first diagnosed as having TTH by the alternative criteria were also classified as having TTH by the standard criteria. If the standard criteria were not applied, the remaining 348 patients were subclassified as having probable migraine (115, 19.6%) and unclassified headache (233, 39.7%). Compared with subjects diagnosed with TTH using the standard criteria, those diagnosed using the alternative criteria were less likely to demonstrate unilateral, pulsating headache, which is aggravated by movement, photophobia, phonophobia, and osmophobia.ConclusionUsing the alternative criteria, less than half of the subjects with TTH according to the standard criteria were classified as having TTH. All the subjects with TTH by the alternative criteria were classified as having TTH by the standard criteria. This study also demonstrated that subjects diagnosed with TTH using the standard criteria could include people with headaches showing migrainous features.
Highlights
According to the third beta edition of the International Classification of Headache Disorder (ICHD-3 beta), the diagnostic criteria for tension-type headache (TTH) might lead to the inclusion of individuals with headaches showing migrainous features
The prevalence of TTH according to the standard criteria and the alternative criteria Of the 2,762 participants, 1,299 (47.2%) subjects had at least one attack of headache, and 586 subjects (21.3%, 95% confidence interval (CI) 19.8–22.8%) were classified as having TTH according to the standard criteria during the previous year
Classification of subjects with TTH according to the standard criteria and the alternative criteria Of the 586 subjects diagnosed with TTH using the standard criteria, 238 (40.6%) subjects were classified as having TTH according to the alternative criteria (Figure 2-A)
Summary
According to the third beta edition of the International Classification of Headache Disorder (ICHD-3 beta), the diagnostic criteria for tension-type headache (TTH) might lead to the inclusion of individuals with headaches showing migrainous features. To better define TTH, the alternative diagnostic criteria were proposed in the appendix of ICHD-3 beta. This study attempted to test the alternative criteria for diagnosis of TTH proposed in ICHD-3 beta in a population-based sample from Korea. Tension-type headache (TTH) is the most prevalent headache disorder in the general population, mostly ranging from 20% to 60% [1,2,3]. The diagnosis of TTH completely relies on clinical symptoms, which are less specific than those of migraine or other headaches. The diagnosis of TTH is mainly based on the absence of typical features found in other types of headache. TTH has been considered to be a featureless headache [7]
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