Tension Type Headache

Question 1

Describe the presentation of a tension type headache [5]

Answer 1

bilateral
non-pulsatile
mild-to-moderate pain with a pressing or tightening quality.
often described as a ‘tight band’ around the head or a pressure sensation.
may be related to stress
not associated with aura, nausea/vomiting or aggravated by routine physical activity

NB: Symptoms tend to be bilateral, where as migraine is typically unilateral

Question 2

Tension headaches may be associated with [5]

Answer 2

Stress
Depression
Alcohol
Skipping meals
Dehydration

Question 3

Chronic tension-type headache is defined as a tension headache occur on [] or more days per month.

Answer 3

Chronic tension-type headache is defined as a tension headache occur on 15 or more days per month.

Question 4

NICE produced guidelines on the management of tension-type headache in 2012:
acute treatment [3]
prophylaxis [2]

Answer 4

acute treatment:
- aspirin, paracetamol or an NSAID are first-line

prophylaxis:
- NICE recommend ‘up to 10 sessions of acupuncture over 5-8 weeks’
- low-dose amitriptyline is widely used in the UK for prophylaxis against tension-type headache.