Tension headache Flashcards
Description
Most common type of headache, not associated with another underlying condition
- migraine
- tension
- cluster, trigeminal neuralgia
Trauma Infections Medication overuse (15/30 day OTC use) SOL HTN TMJ, sinus, eyes/ears
Epidemiology
Most common primary headache disorder
-thought to make up 1/3 of all headache disorders
Females slightly more affected than males
Onset generally between 20-30 with prevalence peaking between 20-39 and then declining
Aetiology
Lifestyle factors
- stress, anxiety
- poor posture
- tiredness, squinting
- dehydration, missing meals
- lack of physical activity
Environmental factors
- bright sunlight
- noise
- certain smells
Pathology
Interaction of different factors that involve pain sensitivity, perception and neurotransmitters
Abnormalities in nerves in brain and spine => increased sensitivity to pain
Release of seretonin, NO may activate nerve pathways in brain, muscles => signals from the muscles around the head are interpreted as pain
Symptoms
Generalised bilateral pressure, tightness around head that may spread into the neck
Lasts minutes to days
Not made worse by ADLs
No associated nausea, ANS symptoms
Not pulsatile
Differentials
Vascular
- subdural bleeds
- intracerebral bleeds
Idiopathic/iatrogenic
- medication overuse headaches => triptans, analgesics, opioids,
- cluster headache => severe unilateral burning around the eye, temple, agitation and restless
Trauma
-recent head/neck trauma => cerebral bleeds
Infective/inflammatory
- meningitis => confusion, neckstiffness, fever
- encephalitis, abscess
- sinusitis
- otitis media
- post herpetic neuralgia
Neoplastic
- head neoplasms,
- mass occupying lesions => in elderly
Degenerative
-TMJ headache from osteoarthirits => tight, painful jaw, clicking, linked to teeth grinding
Endocrine/environmental
- migraine => photophobia, aura, nausea, vomiting, unilateral
- preeclampsia => high BP, proteinuria, blurry vision, edema, N+V
- CO poisoning
Signs
WANT TO RULE OUT RED FLAG SECONDARY CONDITIONS
Vital signs => rule out inflammatory or infective causes
General => rashes, confusion?
- examine sinuses => rule out sinusitis
- carotid, temporal arteries => rule out TIAs, temporal arteritis
- neck stiffness
Neurology
- papilloedema, pupillary asymmetry => rule out increased intracranial pressure due to many reasons, III issues
- any aura => migraines
- dizziness => strokes, decreased perfusion?
Diagnostic criteria
According to the International Classification of Headache Disorders
Recurrent episodes lasting 30mins-7days
- no N+V
- may have either photo/phonophobia
Bilateral location
Pressing, tightening, non pulsating
Mild/moderate intensity
Not aggravated by ADLs
Investigations
Normally a diagnosis of clinical judgement
Investigations aim to rule out more serious secondary causes
Management
Pharmacological
-simple analgesia to take as soon as attack starts => consider comorbidities (paracetamol, aspirin, NSAID)
Lifestyle
- stress management?
- address potential triggers
If medication overuse headache suspected, ask them to keep a medication diary
Prognosis
Infrequent episodic tension headaches are common
- self limiting
- simple analgesia is usually enough
However, if it is chronic
-can lead to decrease in QOL, high disability
Red flags
Sudden onset (within 5min), worst pain ever - subarachnoid bleed
New onset in 50+ - SOL, temporal arteritis
Long progressively worsening pain - SOL, subdural bleed (can be months)
Atypical aura or on COCP (1hr+, weakness, sounds more neuro) - CVA
New neuro deficit - CVA, SOL, hematoma
Papilloedema - malignant HTN, SOL
Confusion, fever, seizure, low GCS - meningitis, encephalitis
Vomiting - SOL, CO poisoning
Visual changes - glaucoma, temporal arteritis
Pregnancy - preeclampsia
Nausea Comiting Fever Positional changes B symptoms Eye symptoms - glaucoma Neuro signs
Common presentations
Uncommon presentations
Long Hx headaches
Clear aura, triptan use
Life stress
New meds
Unusual triggers
Analgesia use
