Tension headache Flashcards
define tension headache
Every day Headache
can be episodic or chronic
Rarely disabling or associated with any significant autonomic phenomena-> dont seek medical care and usually successfully self-treat
Attacks generalised across head-> frontal and occipita;
tight band around head
not worse with physical movement
what are the 2 division of tension headaches?
Episodic - occurs on < 15 days per month
Chronic - occurs on > 15 days per month
state some triggers of tension headaches?
Stress/anxiety - usually in the afternoon after long working hours
Sleep deprivation
Squinting
Poor posture
Fatigue
Dehydration
Missing meals
Bright sunlight
Noise
They are primary headaches (i.e. they have no underlying cause)
summarise the epidemiology of tension headaches?
MOST COMMON type of headache
More common in WOMEN
Most common in YOUNG ADULTS
what are the appropriate investigations for tension headaches?
NO investigations necessary
Maybe give CT or MRI or lumbar puncture is headache pattern has changed
generate a management plan for tension headaches?
Episodic Tension Headaches
Reassurance
Hot/ cold packs
Address triggers (e.g. stress, anxiety, posture)
Stretching and relaxing exercises
Advice on avoiding medications that can cause medication-induced headaches (e.g. opioids)
Simple analgesia (e.g. ibuprofen, paracetamol, aspirin) - for acute attack
Tricyclic antidepressants may be considered in frequently recurrent episodic tension headaches or chronic tension headaches and if this doesn’t work second line is muscle relaxant (tizanidine)
what are the possible complications of tension headaches?
Overreliance on non-prescription caffeine-containing analgesics
Dependence on narcotic analgesics
GI bleed from NSAIDs
Higher risk of epilepsy
what is the prognosis for pateints with tension headaches?
good but recur-> not severe or disabling
what are the presenting symptoms and signs of tension headaches?
Mild-moderate in severity
Pressure/tightness around the head like a tight band
Pain tends to be bilateral in frontal-occipital location
Non-pulsatile
+/- scalp muscle tenderness
SCM, trapezius, temporalis, lateral pterygoid, masseter muscle tenderness
Pain associated with neck flexion – must be distinguished from nuchal rigidity associated with meningeal irritation
Can be disabling for a few hours but does not have specific associated symptoms (unlike migraines)
Gradual onset
Variable duration (30 mins to 7 days)
No prodrome
Usually responsive to over-the-counter medication
IMPORTANT: check for possible triggers when taking history (e.g. stress)
Examination is usually NORMAL
