Tension-type Headache and Its Association

Tension-type headache (TTH) is the most prevalent primary headache disorder and one of the most common neurological disorders. It is characterized by recurrent episodes of mild to moderate headache that are typically bilateral, pressing or tightening in quality, and is not aggravated by routine physical activity. Unlike migraine, TTH is usually not accompanied by nausea or vomiting, although either photophobia or phonophobia may be present. The diagnosis of TTH is based on the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria.

Tension-type headache is classified according to attack frequency into three main types:

• Infrequent episodic tension-type headache (IETTH): headache occurs on less than one day per month on average (fewer than 12 days per year).
• Frequent episodic tension-type headache (FETTH): headache occurs on 1 to 14 days per month on average for more than three months (12 to 179 days per year).
• Chronic tension-type headache (CTTH): headache occurs on 15 or more days per month for more than three months (at least 180 days per year). This subtype is associated with greater disability and a more substantial impact on daily functioning and quality of life.

There is a strong association between tension-type headache and smartphone use. There is also increasing evidence for the association of TTH with sleep quality, causing sleep disturbances including insomnia, poor sleep quality, excessive daytime sleepiness, and insufficient sleep. However, there are limited studies in Egypt that have examined the associations between tension-type headache, smartphone use, sleep quality, and quality of life.

Inclusion criteria

• Adults aged 18-60 years
• Attending the outpatient clinics at Assiut University Hospitals during the study period
• Able to understand the study questionnaires and provide informed consent
• No severe psychiatric illness or cognitive impairment interfering with questionnaire completion
• No serious medical illness that may affect participation

Exclusion criteria

• History of major neurological diseases (e.g., stroke, epilepsy, brain tumors)
• History of secondary headache disorders
• History of migraine or other primary headache disorders according to ICHD-3 criteria
• Refusal to participate