Snapshot A 28-year-old male lawyer presents with headache. He describes the headache as of tightening quality on both sides of his forehead. It is non-throbbing, but feels like a "tight cap." He denies phonophobia or photophobia. On physical exam, there is pericranial muscle tenderness. Introduction Most common type of headache usually described as nonthrobbing usually does not have associated features Mean age ~ 30 years old Mental tension and stress are important precipitating factors however, these symptoms are just as frequent in migraine headache Presentation Symptoms bilateral "band-like," "tight cap" nonthrobbing headache not worsened by physical activity uncommon to have phonophobia or photophobia Physical symptoms pericranial muscle tenderness absence does not rule out diagnosis Evaluation Clinical diagnosis Differential Migraine headache Medication overuse headache Cluster headache Secondary causes of headache head injury vascular disorder infection Treatment Identify headache triggers Acute therapy NSAIDS (first-line) acetaminophen (first-line) Prophylactic therapy amitriptyline (first-line prophylactic treatment) Prognosis, Prevention, Complications Prevention prophylactic therapy Complications reduced productivity functional impairment