Tension-type headache (TTH) is the most common primary headache disorder. Intracranial hypertension (ICH), especially idiopathic intracranial hypertension (IIH), is a secondary cause of headache that can threaten vision if not promptly diagnosed and treated.To review the clinical phenotype, pathophysiology, diagnostic overlap, and management considerations of TTH-like headaches in the context of elevated intracranial pressure. Narrative synthesis of classification criteria, clinical studies, and recent literature on headache phenotypes in intracranial hypertension. Headache in IIH can mimic TTH and migraine phenotypes, lacking unique clinical features, thus complicating diagnosis. Comprehensive evaluation including neuroimaging, funduscopic examination, and cerebrospinal fluid pressure measurement is crucial.  TTH-like headache may represent symptomatic headache attributed to intracranial hypertension. Awareness of subtle distinguishing features and appropriate diagnostic workup is critical to prevent delayed diagnosis and adverse outcomes.

tension-type headache; idiopathic intracranial hypertension; secondary headache; intracranial pressure; headache classification

Quiros et al. Headache was a common and varied symptom in patients with idiopathic intracranial hypertension, including tension-type and probable tension-type phenotypes. Headache 2017;57(8):1195–1205.

Mollan et al. Headache in idiopathic intracranial hypertension: review of mechanisms and clinical management. Egypt J Neurol Psychiatry Neurosurg. 2023.

Validation of ICHD-3 criteria for IIH headache shows that phenotype often cannot distinguish migraine-like from tension-type-like presentations. J Headache Pain. 2025.

IIHTT Trial: Headache phenotypes in IIH include migraine and tension-type headaches and impact headache disability. PubMed.

ICHD-3 criteria for headache attributed to intracranial hypertension. International Headache Society.