Tension headache

Question 1

What may someone with a tension headache present with

Answer 1

Bifrontal/occipital pain

episodic in nature

pressure/ band-like tightness around the head

lasts few hours

can co-exist with other types of headaches

usually no associated nausea/autonomic symptoms

peri-cranial tenderness may be present on palpation

Question 2

What are some risk factors

Answer 2

stress
fatigue
mental tension

Question 3

What is the first line of investigation

Answer 3

Clinical diagnosis - normal neurological examination

Question 4

What are other investigations to order

Answer 4

If headache is refractory or progressing

• CT sinus- exclude sphenoid sinusitis

-MRI - exclude brain tumour

-Lumbar puncture - exclude infective causes, sinus venous thrombosis , pseudotumour cerebri

Question 5

What is management for acute tension headache

Answer 5

simple analgesics- aspirin , paracetamol, ibuprofen , naproxen

physical therapy to neck if there is any stiffness

Question 6

What is management for chronic tension headaches

Answer 6

Anti-depressant - amitriptyline or doxepin

Muscle relaxant - TIZANIDE

Consider non-drug therapies

Question 7

What other management methods are there

Answer 7

prophylactic acupuncture

Question 8

What questions should be asked to exclude some secondary causes of headaches

Answer 8

trauma/injury

intracranial haemorrhage , venous thrombosis

giant cell arteritis

space-occupying lesions

substance misuse

meningitis, encephalitis

angle closure glaucoma

TMJ dysfunction,dental problems, ENT problems