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Letter to the editor concerning Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J. EFNS guideline on the treatment of tension‐type headache – report of an EFNS task force. Eur J Neurol 2010; 17: 1318–1325

1. The authors state that the definitions of the recommendation levels follow the EFNS criteria , which are laid down in the Guidance for the preparation of neurological management guidelines by EFNS scientific task forces – revised recommendations 2004 [2]. The declaration of the level of recommendation ( rating of recommendations ) for each recommendation in a guideline should, according to this Guidance, enable the reader to evaluate the underlying scientific evidence. To this aim, the available scientific evidence should be categorized individually into Class I to Class IV , from which the level of recommendation directly results. As the acceptance of, and adherence to, a guideline is essentially determined by the transparency and comprehensibility of the recommendations, a presentation of the individual evaluations according to Class I to Class IV should be expected, at least in table format. This is not provided by Bendtsen et al. The fact that such a disclosure would cause the guideline to be greater in length is not a sufficient argument against providing it, as the EFNS Guidance explicitly envisages that Supplementary material may be published on the EFNS website . This point is particularly emphasized in the precursory EFNS Guidance: Where appropriate, the evidence concerning health care interventions must be based on a thorough systematic literature search and review. The task force should publish a systematic review in the Cochrane Library if one does not exist [3].