Tension headaches Flashcards
Describe the character of tension headaches
Non pulsating, tightening headache
Where is the headache?
Bilateral, like a band, extends to neck
How long do they last?
Minutes to days
Associated symptoms
no associated nausea or autonomic symptoms, however photophobia or phonophobia may be present in some cases.
Worsened by anything?
Not made worse by the patient’s day activities
Signs
Sometimes pericranial tenderness
Treatment for tension headaches?
Aspirin
Paracetamol
NSAIDs if no contraindication
Prophylaxis
Amitriptyline
What might cause a secondary headache?
Trauma or injury related
Intracranical haemorrhage, venous thrombosis
Giant cell arteritis
Space occupying lesions – neoplasms, abscesses
Substance misuse – either withdrawal or exposure to
Meningitis, encephalitis
Angle closure glaucoma
TMJ dysfunction, dental problems, ENT problems – sinusitis etc.
What questions would you need to ask if a patient came back with another headache?
Has there been any recent trauma or injury?
Has she experienced any recent fevers?
Any recreational drug abuse?
Any associated neurological symptoms?
When would you refer someone with a headache?
If the headache wakes the patient up
Is brought on by changes in posture
Precipitated by physical exertion
Is sudden onset in a pt over 50
OR if the patient has a history of cancer and HIV, or shows signs of infection
What counts as chronic tension headache?
15 or more days per month, on average for more than 3 months
Tension headache
Explain and educate
headache diary
simple analgesia
Ensure no medication overuse (as this can cause headaches)
What would you offer for tension headaches which are chronic?
Acupuncture
Amitryptaline
