Tension Headache

Question 1

Define tension headaches

Answer 1

DEFINITION: the most common type of headache, which is considered a ‘normal, everyday headache’.
Pressure/tightness around the head like a tight band.

Can be divided into:
Episodic - occurs on < 15 days per month
Chronic - occurs on > 15 days per month

Question 2

Explain the cause of tension headaches

Answer 2

The exact cause is unclear

There are well-known triggers: 
Stress/anxiety  
Squinting  
Poor posture  
Fatigue  
Dehydration 
Missing meals  
Bright sunlight  
Noise  

They are primary headaches (i.e. they have no underlying cause)

Question 3

Summarise the epidemiology of tension headache

Answer 3

MOST COMMON type of headache

More common in WOMEN

Most common in YOUNG ADULTS

Most people will experience a tension headache at some point in their lives

Question 4

Recognise the presenting symptoms and signs of tension headaches

Answer 4

Mild-moderate in severity
Pressure/tightness around the head like a tight band
Pain tends to be bilateral

Often a relationship with the neck
Can be disabling for a few hours but does not have specific associated symptoms (unlike migraines)

Gradual onset
Variable duration
Usually responsive to over-the-counter medication

IMPORTANT: check for possible triggers when taking history (e.g. stress)
Examination is usually NORMAL

Question 5

Investigations and management?

Answer 5

NO investigations necessary

Management;

1. Episodic Tension Headaches
   - Reassurance
   - Address triggers (e.g. stress, anxiety)
   - Advice on avoiding medications that can cause medication-induced headaches (e.g. opioids)
   - Simple analgesia (e.g. ibuprofen, paracetamol, aspirin)
   - Tricyclic antidepressants may be considered in frequently recurrent episodic tension headaches or chronic tension headaches

Question 6

Prognosis?

Answer 6

GOOD

Not very severe or disabling

Recurs