[25] Tension Headaches Flashcards

1
Q

How common are tension headaches?

A

The most common type of primary headache

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2
Q

What can tension headaches be divided into?

A
  • Episodic

- Chronic

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3
Q

What are episodic tension headaches?

A

Occur on fewer than 15 days each month

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4
Q

What are chronic tension headaches?

A

Occur on more than 15 days each month

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5
Q

Why is the frequency of tension headaches important?

A

It gives an idea as to the cause

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6
Q

What is more likely to cause episodic tension headaches?

A

Comorbidities such as depression

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7
Q

What is more likely to cause chronic tension headaches?

A

Medication

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8
Q

What can often be misdiagnosed as a tension headache?

A

Migraine

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9
Q

What are the risk factors for tension headaches?

A
  • Anxiety
  • Stress
  • Sleep problems
  • Young age
  • Poor health
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10
Q

How do tension headaches typically present?

A

Mild to moderate generalised headaches described as pressure or tightness

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11
Q

At least 2 of what features suggest tension headaches?

A
  • Bilateral/generalised
  • Mild-moderate
  • Interfering with activities but not preventing
  • Frontal-occipital
  • Non-pulsatile
  • Not aggravated by routine physical activity
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12
Q

How do tension headaches compare to migraines?

A
  • More gradual onset
  • More variable in duration
  • More consistent quality
  • Less severe
  • Usually respond to OTC medication
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13
Q

What findings are found in examination in tension headaches?

A

Nothing - normal examination

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14
Q

Where can tenderness radiate to in tension headaches?

A

Scalp and neck

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15
Q

What investigations are required in tension headaches?

A

None, unless to exclude other pathologies

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16
Q

What are the differentials for tension headaches?

A
  • Migraine
  • Temporal arteritis
  • Trigeminal neuralgia
  • TMJ dysfunction
  • Subarachnoid haemorrhage
  • Sinusitis
  • Encephalitis
  • Cervical spondylosis
  • Carbon monoxide poisoning
17
Q

What are the management components for episodic tension headaches?

A
  • Non-pharmaceutical

- Pharmaceutical

18
Q

What are the non-pharmaceutical management steps for episodic tension headaches?

A
  • Manage stress, anxiety and depression
  • Advise exercise and good posture
  • Advise to avoid certain medications
  • Avoid dehydration
19
Q

What medications should be avoided in tension headaches that can cause medication induced headaches?

A
  • Opioids (including codeine)
20
Q

What is the first line medication for episodic tension headaches?

A

Ibuprofen

21
Q

What is the medication of choice for chronic tension headaches?

A

Amitriptyline (and other TCA’s)

22
Q

What sort of dose of amitriptyline is used for tension headaches?

A

Low dose

23
Q

What are the second line medications for chronic tension headaches?

A

Muscle relaxants e.g. tizanidine