Clearly there are patients with major psychological problems who have psychogenic headaches as a feature of their disorder, but in a majority without features which permit a diagnosis of probable or definite migraine, the distinction is often difficult. Muscle contraction or tension headaches do overlap significantly with migraine, as indicated above, and may respond to similar therapy. Antidepressant therapy in the form of tricyclics may be helpful in both muscle contraction and migraine headaches. In the International Headache Society Classification, there is a classification 2.3 for headaches of the tension-type, not fulfilling the above criteria. This includes oral mandibular dysfunction or temporal mandibular joint pain dysfunction syndrome which is discussed elsewhere.
Diagnostic criteria are the following.
This includes anxiety and depression or headache as a delusion or an idea. Previously used terms include psychogenic headache, or a conversion cephalalgia. It should be obvious that virtually all types of headaches are, at least to some extent, dependent on emotional factors and individual personalities. Their description of the severity, continuity, and bizarre features of the headache is usually sufficient to indicate the diagnosis. Most essential to the diagnosis is evidence for a basic personality disorder, of which the headache is but a part.