(!) Tension headache

Question 1

Presentation of tension-type headache

Answer 1

Dull,bilateral headache that feels like constricting around the head, not debilitating
rarely severe
associated with neck and pericranial pain

often comes after stress, lack of sleep, lack of hydration

doesnt worsen with activity

Neuro exam should be fully normal

always consider important differentials- medication overuse headache, other headaches
AND
GCA, Space occupying lesion, infection, raised ICP etc
(systemic sx)

Question 2

ix and Mx of tension type headaches

Answer 2

Ix- no need except if red flags
consider CT if refractory

Mx
Avoidance of trigger, stress, sleeping well etc

meds-
Acute-paracetamol, ibuprofen, Aspirin (think PPI/ulcer cover)
Stronger shouldnt be used—-> medication overuse headache
if need more- reconsider diagnosis

Prophylaxis- Low dose TCA can rarely be used if very common

Surg-None