Tension Headache

Question 1

What are the different types of tension-type headahce (TTH)

Answer 1

• Infrequent = <12days per year
• Frequent = >12 days per year <3 months
• Chronic = >3months a year or >180days

Question 2

Who gets TTHs

Answer 2

• F>M (1.4:1)

Question 3

How common are TTHs

Answer 3

70-80% lifetime risk
Infreq = 48%
Freq = 34%
Chronic = 2-3%

Question 4

What causes TTHs

Answer 4

• Not fully understood
• Stress
• Myofascial triggers
• increased muscular activity w/in scalp
• Sleep disruption

Question 5

What is the clinical presentation of TTHs

Answer 5

At least 2 of following
- Bilateral
- Pressing/tightening quality (NOT-PULSATILE)
- NOT aggravated by routine physical activity (walking/ climbing stairs)
- Mild to mod intensity
BOTH OF FOLLOWING
- Not associated with N+V
- No more than 1 of photophobia or phonophobia
IT MAY ALSO
- Radiate to or arise from neck
- Be ass w. structural or functional cervical or cranial MSK abnormality
- be stress related

Question 6

How do you investigate TTHs

Answer 6

• BP, papilloedema, exam head + neck for muscle tenderness, stiffness limit ROM + crepitation
• Headache diary
• Ask about depression/ poss triggers

Question 7

How do you treat TTHs

Answer 7

• Exclude 2o causes e.g. space occupying lesion, medication overuse, caffeine withdrawal
  EPISODIC
• Symptomatic Tx (paracetamol, NSAIDS, aspirin - avoid opioids or triptans)
  CHRONIC
• Exclude Dx chronic migraine
• Prevent using acupuncture or amitriptyline