tension headache

Question 1

def tension headache

Answer 1

either episodic or chronic

rarely disabling or associated with aiutonomic phenomena - therefore pts self-treat

Question 2

aetiology tension

Answer 2

Muscle contraction is often considered the cause of pain in tension-type headaches

Extended periods of mental tension or psychological stress may play a role in central sensitisation and the development of chronic tension-type headache

Question 3

RF tension

Answer 3

mental tension

stress

missing meals

fatigue

disturbed sleep patterns - episodic headache

insomina and other sleep disorders - chronic

Question 4

pathophysiology tension

Answer 4

release and activation of inflammatory agents = sensitisation of peripheral trigeminal afferents = in central hypersensitivity.

the major nociceptor is the pericranial musculature (in migraine - bv and meningeal nociceptors)

Those with chronic tension-type headache have a state of generalised hyperalgesia, suggesting central sensitisation

Question 5

epi tension

Answer 5

most common headaches

In adults, the mean global prevalence of tension-type headache = 42%

Question 6

sx tension

Answer 6

constricting pain - tight band - bilateral, non-pulsatile headache +- scalp muscle tenderness

generalised throughout the head - predilection for involving the frontal and occipital regions.

It does not worsen with routine physical activity

non-pulsatile

Question 7

Ix tension

Answer 7

clinical diagnosis - typical headache without associated features (nausea, vomiting); normal neurological examination

Imaging and laboratory studies do not aid in the diagnosis of tension-type headaches and should only be considered in refractory or progressive cases - CT sinus, MRI, LP - to exclude secondary

Question 8

Mx tension

Answer 8

goal - reduce discomfort and duration of attacks

pts with episodic - self-treat

Episodic attacks generally respond well to simple analgesics, such as paracetamol, ibuprofen, or aspirin - all at early stage of attack

If the frequency of attacks becomes high, stronger analgesics have limited use - risk of chronic headache - ‘medicine-overuse syndrome’ (also termed ‘analgesic rebound’): analgesics stop working and perpetuate and intensify the headaches.

Preventative medicines when patients experience >7 to 9 headache days per month. Low-dose tricyclic antidepressants may reduce the frequency and intensity of attacks; amitriptyline in chronic tension-type headache. doses used are generally lower than the range used to treat depression

muscle relaxants eg Tizanidine 2nd line

Relaxation training, electromyographic biofeedback, cognitive behavioural therapy, and myofascial trigger point-focused massage

Question 9

complications tension

Answer 9

peptic ulcer secondary to NSAIDS use

Question 10

Px tension

Answer 10

They are most common between the ages of 20 to 39 years and then decline. Self-treatment with simple analgesic medicine is usually effective.