tension headache

Question 1

definition

Answer 1

Tension-type headaches can be either episodic or chronic.

Stress and mental tension are common triggers.

Symptoms include dull, non-pulsatile, bilateral, constricting pain (not severe); pericranial tenderness is common.

The attacks are generalised throughout the head with a predilection for involving the frontal and occipital regions. The pain is typically expressed as being a ‘tight band’ around the head. It does not worsen with routine physical activity.

Unlike migraine, there is no significant nausea, no vomiting, and a lack of aggravation by routine physical activity.

Usually responds to simple analgesics; preventative treatments have less evidence for their effectiveness.

Non-drug therapies include relaxation, electromyographic biofeedback, cognitive behavioural therapy, and physiotherapy.

Question 2

symptoms

Answer 2

headache often bilateral pressure-like and non-throbbing pain.
usually frontal or occipital regions
“tight band around head”

Question 3

risk factors

Answer 3

mental tension
stress
fatigue
missing meals

Question 4

investigations

Answer 4

1st:
clinical diagnosis

others:

• CT sinus (May be considered in cases of refractory or progressing headaches to exclude sphenoid sinusitis.)
• MRI brain (exclude brain tumour)
• Lumbar puncture (exclude infective causes)

Question 5

treatment

Answer 5

ongoing attack:
analgesics (aspirin, paracetamol etc.)

chronic (7-9 headache days/month)
1. low dose antidepressants (dose lower than to treat depression) -- amitryptilline
\+ relaxation
\+ face massage 
\+ EMG biofeedback
2. muscle relaxants -- tizanidine