Tension headache

Question 1

Define tension headache

Answer 1

Headache generalised through the head with a predilection for involving the frontal and occipital regions
Either episodic or chronic
Rarely disabling or associated with any significant autonomic phenomena
Do not tend to seek medical care as they successfully self-treat

Question 2

What is the aetiology for tension headaches

Answer 2

Often thought to be due to peri-cranial muscle contraction (little evidence to support)

triggered by psychological stress, associated with insomnia and sleep disorders

Question 3

What are the risk factors for tension headache

Answer 3

Mental tension
Stress
Missing meals
Fatigue
Somatisation | female sex | 20-39 |lower socioeconomic status | analgesic overuse

Question 4

What are the symptoms of tension headache

Answer 4

Headache
- Often frontal and occipital regions
- Bilateral
- Gradual or acute onset
- Dull, non-pulsatile, constricting pain - “tight band around the head”
- 3-4 hours
- Exacerbated by stress, exertion, lack of sleep
- Relieved by analgesic
Photophobia/phonophobia

(normal exam)

Question 5

What is the management for tension headache

Answer 5

Clinical diagnosis

Acute: analgesia e.g. paracetamol, aspirin, ibuprofen

Chronic: antidepressants e.g. amitryptilline
- EMG biofeedback
- Relaxation training
- CBT
- Acupuncture
- Physiotherapy
- Hypotherapy

Question 6

What classifies chronic tension headache

Answer 6

> 7-9 headache days/months

Question 7

What are the complications from treatment of tension headache

Answer 7

Peptic ulcer from repeated NSAID use
Medication overuse headache