Tension Headache Flashcards
What is a tension headache?
- Tension-type headaches can be either episodic or chronic.
- rarely disabling or associated w any significant autonomic phenomena,
- patients don’t usually seek medical care and usually successfully self-treat.
- attacks are generalised throughout head w predilection for involving frontal & occipital regions.
- pain is typically expressed as being a ‘tight band’ around head.
- It does not worsen with routine physical activity.
What is the criteria that defines a tension headache as chronic?
chronic symptoms (>7-9 headache days/month)
What is the classification of tension headaches?
ICHD classification
- Infrequent episodic tension-type headache
- Frequent episodic tension-type headache
- Chronic tension-type headache
- Probable tension-type headache
What is the cause of tension headaches?
They are PRIMARY headaches i.e. no underlying cause
- cause of pain = pericranial muscle contraction
- little evidence
- extent of muscle contraction ≠ correlate w extent of pain
- triggered by psychological stress
Episodic tension-type headache
- triggered by disturbed sleep patterns
Chronic tension-type headache
- Extended periods of mental tension / psychological stress ~ –> central sensitisation
What is the major pathophysiological difference between tension headaches & migraines?
BOTH:
release & activation of inflammatory agents –> sensitisation of peripheral trigeminal afferents –> ultimately in central hypersensitivity
tension headaches
- major nociceptor is the pericranial musculature
migraines
- major nociceptor is the blood vessels and meningeal nociceptors
Which comorbidities are commonly seen w tension headaches?
- Anxiety
- depression
but no causative link identified
What are the risk factors for tension headaches?
- mental tension
- stress
- missing meals
- fatigue
Name some weaker risk factors for tension headaches
- somatisation
- female sex
- age 20-39 years
- lower socioeconomic status
- analgesic overuse
Summarise the epidemiology of tension headaches
- most common type of headache
- global prevalence of tension-type headache is 42%
- prevalence peaks at ages 20- 39 yrs and then declines
- only slight higher prevalence in females
- 2:3 male to female ratio
- migraines = greater prevalene in females vs males
What is the general age of onset of tension headaches?
20 to 30 years
What are the presenting symptoms of tension headaches?
- generalised head pain
- frontal / occipital head pain
- non-pulsatile head pain
- constricting pain
- ‘tight band’
Describe the type of pain in tension headaches
- Mild-moderate in severity
- Pressure/tightness around the head
- like a tight band
- bilateral
- Often a relationship with the neck
- Can be disabling for a few hours but no specific associated symptoms
- (unlike migraines)
- Gradual onset
- Variable duration
- Usually responsive to over-the-counter medication
What are the signs of tension headaches O/E?
- normal neurological examination
tenderness (muscle)
- pericranial
- SCM
- trapezius
- temporalis
- lateral pterygoid
- masseter
Name some uncommon signs/symptoms of tension headaches
- photophobia or phonophobia
- regular analgesic use
- anxiety and depression
- somatisation
What are the primary investigations for ?tension headache?
diagnosis is clinical
- typical headache w/o associated features (nausea, vomiting)
- normal neurological examination
