The key to making the diagnosis of any headache is the history given by the patient. The health care practitioner will ask the appropriate questions to understand when the headache began, learn about the quality, quantity, and duration of the pain, and ask about any associated symptoms. The history of tension headache will include pain that is mild to moderate, located on both sides of the head, described as a tightness that is not throbbing, and not made worse with activity. There will be no associated symptoms like nausea, vomiting, or light sensitivity.
The physical examination is important in tension headaches because it has to be normal to make the diagnosis. The only exception is that there may be some tenderness of the scalp or neck muscles. If the health care practitioner finds an abnormality, then the diagnosis of tension headache would not be considered.