2.1 Infrequent episodic tension-type headache

A 32-year-old female patient, a teacher, presents to the consultation with a complaint of headache.

History of Present Illness:
The patient reports episodes of headache for approximately 6 months. She describes the pain as bilateral, "band-like" or "pressure," with mild to moderate intensity (4-6/10), without pulsation. The pain does not worsen with routine physical activities, such as climbing stairs, and is not associated with nausea, vomiting, photophobia, or phonophobia. The episodes last on average 2 to 4 hours and occur about 1 to 2 times per month. The patient denies visual aura or other neurological symptoms preceding the pain. She notes that stress at work seems to trigger the episodes but does not identify other clear precipitating factors, such as changes in sleep or diet.

Past Medical History:
Hypothyroidism under treatment with levothyroxine, controlled. Denies other comorbidities.

Current Medications:
Levothyroxine 50 mcg/day.

Family History:
Mother with a history of migraine.

Physical Examination:

General: Patient in good general condition, conscious, oriented, hydrated.

Neurological: Examination without alterations, no focal signs, cranial nerves intact, preserved muscle strength, normal reflexes, stable gait.

Palpation of pericranial muscles: Mild tenderness on palpation of the temporal and trapezius muscles, without cervical stiffness.

Diagnostic Hypothesis: