Tension Headache

Question 1

How do tension headaches come on?

Answer 1

episodic or chronic

Question 2

How common are tension headaches?

Answer 2

• Most common type of headache

- Global prevalence: 42%

Question 3

What is the epid for tension headaches?

Answer 3

• 20-30yrs age onset

- Male more common 2:3

Question 4

What are common triggers for tension headaches?

Answer 4

1. Mental tension
2. Stress
3. Missing meals
4. Fatigue

Question 5

What are symptoms and signs of a tension headache?

Answer 5

1. Dull
2. Non-pulsatile
3. Bilateral
4. Constricting pain (not severe)
5. Pericranial tenderness
6. Normal neuro exam
7. Frontal or occipital

Question 6

What are possible DDx for tension headache?

Answer 6

1. Chronic migraine
2. Medicine overuse headache
3. Sphenoid sinusistis
4. Giant cell arteritis
5. TMD

Question 7

What investigations are used for tension headache?

Answer 7

clinical diagnosis

Question 8

What is the management of tension headaches in an acute attack?

Answer 8

simple analgesia (paracetamol and NSAIDs)

Question 9

What is the management of tension headaches with chronic symptoms (>7-9 headache days/month)?

Answer 9

1st line: antidepressants e.g. amitriptyline 10mg

2nd line: muscle relaxants: e.g. tizanidine

Question 10

What are possible non-drug therapies for tension headache?

Answer 10

1. Relaxation
2. Electromyographic biofeedback
3. CBT
4. Physiotherapy

Question 11

What are possible complications for tension headaches?

Answer 11

peptic ulcer from NSAID use