2.3.2 Chronic tension-type headache not associated with pericranial tenderness

A 41-year-old IT consultant reports that he has been troubled by headache for several months. He describes the pain as a steady, band-like pressure rather than a throbbing pain, and it affects both sides of his head, from temple to temple; it generally sits at a tolerable, mild to moderate level. Each episode drags on for hours, sometimes stretching into a full day before it eases, and at its worst it can feel almost continuous. It does not worsen when he exercises or climbs the stairs at work, and he continues his regular gym sessions and dog walks without any flare-up. He has kept a diary and counts headache days on roughly fifteen days out of the month, a pattern that has persisted for around four months. On direct questioning he denies any nausea, has not vomited, and reports no bothersome sensitivity to light or to noise during these episodes; when he presses his own scalp and neck it stays comfortable to palpate, without any tenderness elicited.