Tension Headache

Question 1

Define Tension Headache

Answer 1

Headache generalised through the head with a predilection for involving the frontal and occipital regions

Question 2

Aetiology of Tension Headache

Answer 2

Often thought to be due to muscle contraction

Triggered by psychological stress

Chronic headaches are associated with insomnia and sleep disorders

Question 3

Risk factors for Tension Headache

Answer 3

Mental tension
Stress
Missing meals
Fatigue

Somatisation, female, 20-39, analgesia overuse

Question 4

Symptoms of Tension Headache

Answer 4

Episodic or chronic
Rarely disabling or associated with significant autonomic phenomena
Do not tend to seek medical care

Headache (Frontal + occipital | bilateral | gradual/acute onset | dull, non-pulsatile, constricting “tight band” | 3-4 hours | exacerbated by stress, exertion, lack of sleep | analgesia relieves)

Photophobia/phonophobia

Question 5

Signs of Tension headache on examination

Answer 5

Normal neuro exam

Tenderness (pericranial, SCM, trapzius, temporalis, lateral pterygoid, masseter)

Question 6

Investigations for Tension Headache

Answer 6

Clinical diagnosis (headache without N&V + normal neuro exam)

Consider (refractory or progressing headaches):

• CT sinus: normal (exclude sphenoid sinusitis)
• MRI brain: normal (exclude brain tumour)
• Lumbar puncture: normal (exclude infective causes)

Question 7

Management for an acute Tension Headache

Answer 7

Simple analgesia
Aspirin 300-900mg PO
Paracetamol 500-1000mg PO
Ibuprofen 400-800mg PO

Question 8

Management for an chronic Tension Headache

Answer 8

Conservative
Relaxation training
Cognitive behavioural therapy 
Massage
Acupuncture
Spinal manipulation
Physiotherapy 
Hyponosis

Medical
Antidepressants e.g. amitryptilline 10mg PO at bedtime
2nd line - muscle relaxant e.g. tizanidine PO

Question 9

Prognosis for Tension Headache

Answer 9

Self treatment usually effective

May develop peptic ulcers from repeated NSAID use