Tension Headache

Question 1

What is a tension headache?

Answer 1

A chronic headache that is usually bilateral, non-pulsatile with scalp/muscle tenderness

Question 2

How do patients often describe this type of headache?

Answer 2

Pressure/tightness around the head that often goes into the neck

Question 3

What causes tension headaches? (6)

Answer 3

Anxiety, depression, stress, poor sleep, made worse by eye strain and analgesic over use

Question 4

Are they common?

Answer 4

VERY common, the most common type of chronic headache

Question 5

Who do they affect?

Answer 5

They are more common in women and usually occur before the age of 50

Question 6

Signs and Symptoms (13)

Answer 6

featureless, generalised headache, mild/moderate severity, pressure/tightness, gradual onset, usually fronto-occipital, muscular tightness, neck stiffness, difficulty concentrating, stress, anxiety, insommina, depression

Question 7

Differentials

Answer 7

Migraine, Giant Cell Arteritis, Trigeminal Neuralgia, Sinusitis

Question 8

Investigations (3)

Answer 8

Head and neck examination, blood pressure, fundoscopy, generally doesn’t require any other investigations unless another cause is suspected

Question 9

Management (7)

Answer 9

relaxation, regular exercise, control of stress/anxiety/depression, CBT, acupuncture, NSAIDs, Tricyclics e.g Amitriptyline

Question 10

Is there a good prognosis? (2)

Answer 10

It is a very common problem and usually causes minimal disability but some discomfort, morbidity escalates with chronic tension headache as causes depression