Tension Headache

Question 1

What is tension headache?

Answer 1

Common priomary type of headache

• infrequent episodes
• more than 10 days / months
• chronic >15/7 per months

Question 2

What are presenting symptoms of tension headaches?

Answer 2

• General/ Bilateral headache
  
  • tense feeling (pressure/tightness)
  • arises from neck
• Mild-moderate intensity
• minutes - days
  
  • not aggravated by routine physical activity
• Pericranial tenderness which may be elicited on manual palpation.

Question 3

What are presenting signs of tension headaches on examination?

Answer 3

Normally no specific signs (clinical diagnosis)

• Pericranial tenderness which may be elicited on manual palpation, if presenting w. active headache

*

Question 4

What is the prevalence of tension headaches?

Answer 4

Common (most common primary headache disorder)

• lifetime prevalence : 30-78%
• 1/3 of headache patients
• normally onset between 20-39
• females 5:4 males

Question 5

What are appropriate investigations you would order in a patient with suspected tension headaches?

Answer 5

• explore red flags for secondary type of headache
• if no indication: manage tension headache

Question 6

Summarise the management for patients with tension headaches?

Answer 6

• offer simple analgesic
  
  • paracetamol, aspirin, Ibuprofen
• associated with TTH such as stress, mood disorders, chronic pain and sleep disorders and manage appropriately
• consider preventative treatment

Question 7

When would you offer preventative treatments in tension headaches?

Answer 7

In chronic Tension Headaches

• 15 days or more of headache per month for 3 months or more.

Question 8

Which preventative measurements for tension headaches could you consider?

Answer 8

Offer

• acupuncture
• “off lable” amitriptyline (10-75mg daily)
  
  • if working: attempt withdraw after 4-6 months
• be aware of medication overuse headache

Question 9

What is the prognosis of patient with tension headaches?

Answer 9

• Occasioal Tension Headache
  
  • self-limiting (might require analgesia)
• Chronic TTH
  
  • might lead to impact in quality of life, diability and is a serious condition
  • can develop from frequent episode TT headache

Question 10

What is the cause for the development of tension-type headache?

Answer 10

Not really known

Pericranial pain sensitivity, along with exacerbating environmental factors such as psychological stress, caffeine, or disturbed sleep may lead to central nervous system excitation.

Question 11

What are the risk factors for the development of Tension Type headaches?

Answer 11

• mental tension
• stress
• missing meals
• fatigue

Question 12

What are complications that can develop from tension-type headaches?

Answer 12

• Chroic tension -type headaches
  
  • severe due to huge impact on life
• Medication overuse headache in patient with self-medication

Question 13

What are secondary headache?

Answer 13

Headaches due to an underlying cause

Question 14

What are possible conditions that might cause secondary headaches?

Answer 14

• Trauma or injury related
• Intracranical haemorrhage, venous thrombosis
• Giant cell arteritis
• Space occupying lesions – neoplasms, abscesses
• Substance misuse – either withdrawal or exposure to
• Meningitis, encephalitis
• Angle closure glaucoma
• TMJ dysfunction, dental problems, ENT problems – sinusitis etc.

Question 15

What are red flags that might suggest a more severe unterlying cause of headaches?

Answer 15

• Head trauma
• New onset of headache in a patient over 50 years old
• Thunderclap headache: rapid build up (seconds to 5 minutes), severe
• Headache changes with posture
  
  • e.g. worse when standing, CSF leak
  • Worse when lying down: increased inter-cranial pressure
• Headache waking the patient up
• Headache precipitated by physical exertion
• Involvement of neurological symptoms
• atypical aura
• Contacts with similar symptoms