Diagnostic Challenges in Tension-Type Headache versus Migraine in Busy OPD Settings and Their Impact on Treatment: A Descriptive Study from a South Indian Tertiary-Care Medical College

Abstract Background: Differentiating migraine from tension-type headache (TTH) is difficult in high-volume outpatient departments (OPDs). Misclassification can affect treatment outcomes. Objective: To evaluate diagnostic challenges between migraine and TTH in a South Indian tertiary-care centre and assess their impact on treatment outcomes. Methods: A descriptive study of 100 consecutive patients over one year using structured proforma and ICHD-3 criteria. Results: Among 100 patients, 54 were diagnosed with migraine, 38 with TTH, and 8 with mixed/uncertain features. Major diagnostic challenges included symptom overlap (28%), lack of adequate time in OPD (40%), and incomplete checklist usage (35%). Treatment outcomes were better in correctly diagnosed cases (p<0.05). Conclusion: Structured diagnostic tools and adequate consultation time improve headache classification and treatment success.