TENSION TYPE AND REBOUND HEADACHES

Question 1

what type of headache is tension-type headache classified as?

Answer 1

chronic primary

Question 2

what type of headache is rebound headache classified as?

Answer 2

chronic primary

Question 3

what is the pathophysiology for TTH?

Answer 3

unknown.
likely multifactorial.
maybe increased neuronal sensitivity to pain.
(less likely related to abnormal muscle contraction)

Question 4

what is the most prevalent kind of headache in the general population?

Answer 4

tension type headache

Question 5

what are TTHs defined by?

Answer 5

they are relatively featureless headaches; defined more by the absence of certain sx than the presence

Question 6

what are the 3 main subtypes of TTH?

Answer 6

infrequent episodic TTH (<1 day/month)

frequent episodic TTH (1-14 days/month)

chronic TTH (15+ days/month)

Question 7

what is the clinical presentation of TTH?

Answer 7

generalized head pain; vise-like in quality (NOT pulsatile).
pericranial tenderness.
exacerbated by stress, fatigue, noise/light.
no focal neuro sx
no N/V
associated with depression and anxiety

Question 8

how are TTH diagnosed?

Answer 8

clinical diagnosis. no abnormalities on PE. imaging not usually required.

Question 9

what is the ICHD-3 criteria for diagnosis of EPISODIC TTH?

Answer 9

at least 10 episodes of headache, lasting 30min - 7 days.

at least 2 of:
- bilateral
- tightening (NON-pulsating) quality
- mild/mod intensity
- not aggravated by routine physical activity

*No N/V

*NO MORE THAN ONE OF photophobia or phonophobia

Question 10

what is the ICHD-3 criteria for diagnosis of CHRONIC TTH?

Answer 10

headache lasting hours to days or unremitting, for >15 days per month for more than 3 months on avg

at least 2 of:
- bilateral
- tightening (NON-pulsating) quality
- mild/mod intensity
- not aggravated by routine physical activity

• No more than ONE of photophobia, phonophobia, or mild nausea
• NO mod or severe nausea
• NO vomiting

Question 11

what pharmacotherapy is used for acute treatment (alone or in combination) for TTH?

Answer 11

acetaminophen, aspirin, NSAIDs, and/or caffeine + simple analgesic

Question 12

what pharmacotherapy is used for prophylaxis of TTH?

Answer 12

amitriptyline, nortriptyline, doxepin

Question 13

what forms of behavioral therapy are used for TTH?

Answer 13

general (exercise, diet, sleep)
physical (stretching, TENS, massage)
psychologic (counseling, relaxation exercises, biofeedback)

Question 14

when should preventive therapy for TTH be started?

Answer 14

when TTH are 4+/month

Question 15

what is the goal for trx of TTH?

Answer 15

reduce usage of acute medication trx. and prevent rebound headache

Question 16

what is the best practice for trx of TTH?

Answer 16

medication PLUS behavioral therapy

Question 17

what is the etiology of rebound headache?

Answer 17

consequence of regular overuse of acute/symptomatic HA medication.
occurs on 15< days/month for more than 3 months.

Question 18

what is the clinical presentation of a rebound HA?

Answer 18

exists in combination with, and is preceded by, another HA syndrome (usually migraine or TTH)

HA is present or develops upon awakening!!

trx with acute meds will only provide temporary relief.

Question 19

what is the ICHD-3 criteria for diagnosis of rebound HA?

Answer 19

HA occurs on 15+ days/month in pt with pre-existing HA d/o.

Regular overuse of one or more acute/sx drugs for more than 3 months:
- intake >10 days per month for >3 months of triptans, opioids, or combo analgesics, or any combo of triptans, simple analgesics, and/or opioids
- intake >15 days/month for >3 months of simple analgesics

Question 20

what is the trx for rebound headache?

Answer 20

EDUCATION
Outpatient withdrawal (NOT for benzos, barbituates, or opioids))
- withdraw overused med abruptly
- use bridge therapy with long-acting NSAID (naproxen, celebrex, mobic) or prednisone
- start prophylactic HA medication