Tension Headache

Question 1

Symptoms / Diagnostic Criteria

Answer 1

•	Headache <15d/month
•	Lasts 30 min – 7 d
•	>/ 2:
o	Pressing / tightening (non-pulsatile)
o	Mild-moderate intensity (inhibits 0 prohibits)
o	Bilateral
o	Not aggravated by routine physical activity
•	Both of the following:
o	0 N/V
o	< photophobia / phonophobia
o	R/o organic causes

Question 2

Criteria for Chronic Tension Headache

Answer 2

• > 15 attacks / month

* Fits tension headache criteria

Question 3

Management (Pharm), how many days per month must it be limited to

Answer 3

Use analgesia <9-15 d / month to prevent medication overuse h/a
• Acetaminophen 1,000 mg
• Ibuprofen 400 mg
• Naproxen 500 mg

Question 4

Non-pharmacotherapy management

Answer 4

Non-Pharmacotherapy:
•	Stress Management
•	Physiotherapy
•	Biofeedback + CBT
•	Massage (no evidence)
•	Manual Therapy (no evidence)
•	Acupuncture (equal to placebo)

Question 5

Prevention Medication: first line, second line

Answer 5

First Line:
•	Amitriptyline
•	Nortriptyline
Second Line:
•	Venlafaxine
•	Mirtazapine