Tension headache

• What is a tension headache?


  Most common primary headache disorder

  Characterised by a bilateral, non-pulsatile, mild-to-moderate pain with a pressing or tightening quality
• How can tension headaches be classified?


  According to frequency of attacks

  Infrequent episodic

  • less than 1 day of headache per month (usually self-limiting)

  Frequent episodic

  • at least 10 episodes of headache on fewer than 15 days per month on average, for more than 3 months

  Chronic

  • 15 days or more of headache per month, for more than 3 months, in the absence of medication overuse
• What are the RFs for tension headache?


  Stress & mental tension

  Missing meals

  Fatigue

  Lack of sleep

  Female
• What are the signs & symptoms of a tension-type headache?

  Bilateral, non-pulsatile pain

  Tightness sensation (often described as constant pressure)

  Scalp muscle tenderness (hallmark of tension headaches)

  Normal neurological examination
• What are the Inx of tension-type headache?


  Full Hx & examination
• What are the DDx of tension headaches?


  Migraine

  Medication overuse headache

  Cluster headaches
• What are medication overuse headaches?


  Headache occurring on 15 or more days per month in a person with pre-existing headache disorder which develops as a consequence of regular overuse of one or more drugs that can be taken for acute and/or symptomatic treatment of headache for more than 3 months

  Usually resolves after overused medication is stopped
• What medications can cause medication overuse headaches?


  Paracetamol

  NSAIDs

  Aspirin

  Triptans

  Opioids
• What is the management of tension headaches?


  Analgesia

  Stress management

  Physical therapy (massage or muscle relaxation exercises -> to alleviate scalp & neck tension)