Background: Tension-type headache (TTH) is the most common primary headache disorder worldwide. Urbanization, psychological stressors, and sociocultural factors may influence its epidemiology in Africa. Methods: A cross-sectional, population-based study was conducted in Brazzaville via proportional stratified sampling across the city’s nine districts. Data were collected through a standardized questionnaire and clinical interviews based on the International Classification of Headache Disorders (ICHD-III). The 3-month and 1-year prevalence rates of TTH and its subtypes were estimated. Results: Among the 1650 eligible individuals, 1611 participated (response rate: 97.6%). Primary headaches were reported by 15% of the respondents, 66.5% of whom were diagnosed with TTH. The 3-month prevalence of TTH was 10% [95% CI: 8.5% - 11.5%], adjusted to 9.5% [95% CI: 8.1% - 10.9%] after correction for age and sex, and the adjusted 1-year prevalence was 23% [95% CI: 20.9% - 25.1%]. TTH was episodic (77.6%) or chronic (22.4%), and 33.5% of the participants presented with pericranial tenderness. The median age of participants with TTH was 37 years. The majority were women (male-to-female ratio = 1:2.3), single (51.6%), and employed (54%). Most had secondary (46%) or higher (39.1%) education and reported low (42.9%) or moderate (43.5%) socioeconomic status. Conclusion: TTH is prevalent in Brazzaville, predominantly affecting young, single, educated, and working women living in densely populated areas. Its multifactorial nature underscores the need for targeted prevention and improved headache care strategies in urban African settings.
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