According to her headache history and characteristics, C-TTH was the diagnosis. Her neurological exam was normal. She was started 25 mg amitriptyline daily and increased to 50 mg 10 days after. Three months later, her headache days decreased to 6–7 days a month. Her amitriptyline dosage increased to 75 mg/day. At the fifth month of her treatment, she had only 2–3 headache days per month.

According to the ICHD-3 beta, the definition of C-TTH headache is headaches occurring on ≥15 days per month on an average of >3 months (≥180 days per year), lasting hours or may be continuous; has at least two of the following characteristics: bilateral location, pressing/tightening (non-pulsating) quality, mild or moderate intensity, and not aggravated by routine physical activity such as walking or climbing stairs; and both of the following associating symptoms: no more than one of photophobia, phonophobia, or mild nausea and neither moderate or severe nausea nor vomiting.

A 42-year-old woman was admitted to the ER for the worsening of her continuous headache. This headache was daily, bilateral, tightening, and moderate, starting from the neck radiating to the vertex without any associating symptoms. Her BP was 150/90 mmHg, treated with antihypertensive agents and referred to the cardiology hypertension outpatient clinic. She was put on antihypertensive medication for essential hypertension. Her BP stayed normal for 5 months but her headache did not change. She was then referred to the neurology outpatient clinic and was diagnosed with C-TTH. She was given 50 mg amitriptyline daily, and 3 months later, her headache frequency dropped to 6–7 days a month. Her dosage increased to 75 mg daily and her headache days decreased to 2–3 days a month.