[25] Tension Headaches Flashcards
How common are tension headaches?
The most common type of primary headache
What can tension headaches be divided into?
- Episodic
- Chronic
What are episodic tension headaches?
Occur on fewer than 15 days each month
What are chronic tension headaches?
Occur on more than 15 days each month
Why is the frequency of tension headaches important?
It gives an idea as to the cause
What is more likely to cause episodic tension headaches?
Comorbidities such as depression
What is more likely to cause chronic tension headaches?
Medication
What can often be misdiagnosed as a tension headache?
Migraine
What are the risk factors for tension headaches?
- Anxiety
- Stress
- Sleep problems
- Young age
- Poor health
How do tension headaches typically present?
Mild to moderate generalised headaches described as pressure or tightness
At least 2 of what features suggest tension headaches?
- Bilateral/generalised
- Mild-moderate
- Interfering with activities but not preventing
- Frontal-occipital
- Non-pulsatile
- Not aggravated by routine physical activity
How do tension headaches compare to migraines?
- More gradual onset
- More variable in duration
- More consistent quality
- Less severe
- Usually respond to OTC medication
What findings are found in examination in tension headaches?
Nothing - normal examination
Where can tenderness radiate to in tension headaches?
Scalp and neck
What investigations are required in tension headaches?
None, unless to exclude other pathologies
What are the differentials for tension headaches?
- Migraine
- Temporal arteritis
- Trigeminal neuralgia
- TMJ dysfunction
- Subarachnoid haemorrhage
- Sinusitis
- Encephalitis
- Cervical spondylosis
- Carbon monoxide poisoning
What are the management components for episodic tension headaches?
- Non-pharmaceutical
- Pharmaceutical
What are the non-pharmaceutical management steps for episodic tension headaches?
- Manage stress, anxiety and depression
- Advise exercise and good posture
- Advise to avoid certain medications
- Avoid dehydration
What medications should be avoided in tension headaches that can cause medication induced headaches?
- Opioids (including codeine)
What is the first line medication for episodic tension headaches?
Ibuprofen
What is the medication of choice for chronic tension headaches?
Amitriptyline (and other TCA’s)
What sort of dose of amitriptyline is used for tension headaches?
Low dose
What are the second line medications for chronic tension headaches?
Muscle relaxants e.g. tizanidine
