Tension headache

Question 1

How common is it?

Answer 1

Lifetime risk 70-80% (very surprised it’s not higher)

Question 2

Who does it affect?

Answer 2

About 50% of adults aged 40 years’ experience episodic tension-type headaches. The prevalence is higher in women then men.

Question 3

What causes it?

Answer 3

Not fully understood.

Been associated with the presence of myofascial trigger points, and abnormal central processing of pain (causing increased pain sensitivity).

There appears to be increased muscular activity within the scalp (such as muscle contraction, muscle inflammation, or disturbed metabolism of the scalp muscles).

By definition, it is not caused by other conditions such as a pyrexia illness or medication overuse (though a medication overuse headache is basically the same really.

Question 4

What risk factors are there?

Answer 4

Stress
sleep disturbance
Similar headaches may be caused by depression
family stress
emotional rigidity
caffeine withdrawal

Question 5

How does it present?

Answer 5

Usually bilateral, associated with a pressing or tightening quality (non-pulsating). Not aggravated by routine physical activity such as walking or climbing stairs. Not associated with nausea or vomiting, though anorexia may occur. No more than one of photophobia or phonophobia. They may also frequently radiate from or arise from the neck. Be associated with structural or functional cranial MSK abnormalities. Be stress related.

Question 6

Signs on examination?

Answer 6

General medical history. BP. Neurological examination including fundoscopy for papilledema.

Question 7

Treatment

Answer 7

Reassurance and symptomatic treatment (e.g. paracetamol, aspirin, NSAIDs).

Question 8

Conditions that would present similarly

Answer 8

Migraine without aura, which is often mistaken for a TTH headache and often co-exists. Medication overuse is an aggravation of a prior headache. Pain referred from a source in the neck.