Tension-Type-Headaches Flashcards
What is a primary headache?
1 - no known underlying cause
2 - trauma related headache
3 - infectious related headache
4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures
1 - no known underlying cause
What is a secondary headache?
1 - no known underlying cause
2 - trauma related headache
3 - infectious related headache
4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures
4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures
What is the most common type of primary headache?
1 - migraines
2 - thunderclap
3 - tension type
4 - cluster
3 - tension type
- incidence of 0.5-5%
- difficult to identify exact incidence
In a tension type headache, is the pain bilateral or unilateral?
- bilateral
In a tension type headache, how do patients typically describe the feeling of a tension type headache?
1 - drilling on head
2 - banging on head
3 - squeezing head
4 - all of the above
3 - squeezing head
- this is why its called a tension headache
What is the incidence of tension headaches?
1 - 150/100,000
2 - 1500/100,000
3 - 15,000/100,000
3 - 15,000/100,000
Are men or women more affected by tension headaches?
- equal
Do tension headaches typically present with a severe or mild to moderate severity?
- mild to moderate severity
Are men or women more likely to suffer with a tension headache?
- women slightly
Tension headaches can be episodic or chronic. How many days in a month do tension-type headaches need to occur to be class as chronic?
1 - >5d/month
2 - >1-d/month
3 - >15d/month
4 - >25d/month
3 - >15d/month
- episodic is <15 days per month
How long do tension-type-headaches typically last?
1 - 4-72 hours
2 - 15-180 minutes
3 - 30 minutes to 1 week
4 - >1week
3 - 30 minutes to 1 week
Of the following, which is most likely to trigger a Tension type headaches?
1 - dehydration and stress
2 - food and weather
3 - cigarettes and alcohol
4 - medications
1 - dehydration and stress
Tension type headaches typically present with no specific symptoms. Which of the following is acceptable and can be seen in some patients?
1 - photophobia/phonophobia
2 - aura
3 - nausea and vomiting
4 - autonomic features
1 - photophobia/phonophobia
Medication-overuse headache are caused by taking painkillers too often for tension headaches . The body responds to this by increasing the number of pain receptors in the head.
When pain is felt it is overly sensitive and pain is felt all the time.
When performing a history on a patient with a headache, is an increase in the headaches symptoms when performing the Valsalva bad?
- bad
- indicates a mass or increased fluid overload in the cranial cavity
- Valsalva is an increase in pressure with a closed glottis
When performing a history on a patient with a headache, which of the following is NOT typically a red flag?
1 - patient wakes up with headache
2 - change in character
3 - age of onset
4 - sudden onset (thunderclap)
5 - focal neurological deficits
6 - constitutional symptoms (fever, meningism, rash, weight loss)
1 - patient wakes up with headache
- RED FLAG if it wakes the patient whilst they are asleep
When examining a patient, all of the following are RED FLAGS except which one?
1 - patient appears sick-appearing, skin changes
2 - evidence of trauma
3 - altered cognitive state
4 - ocular: hyphema, pupil non-reactivity, optic disc swelling, proptosis, restricted eye movements
5 - meningism
6 - weight loss
7 - focal neurological findings (eg limb weakness)
6 - weight loss
Which of the following is NOT a differential for a tension like headache?
1 - migraine with aura
2 - medication overuse headache
3 - hypertension
4 - secondary headaches
3 - hypertension
Patients with infrequent (<1 day/month) or frequent (<15 days/month) tension headaches, are advised to take aspirins or NSAIDs as soon as onset of symptoms. However, patients who cannot tolerate aspirin or NSAIDs should be encouraged to take what?
1 - stronger does of aspirin
2 - codeine
3 - morphine sulphate
4 - acetaminophen
4 - acetaminophen
- this is essentially paracetamol
Are primary or secondary headaches more common?
- primary
Do patients with a stable headache pattern for >6 months and an unremarkable neurological examination require brain neuroimaging?
- no
Patients with a stable headache pattern for >6 months and an unremarkable neurological examination do not require brain neuroimaging. However, if they have any of the following they should receive brain neuroimaging:
- unexplained abnormal finding on neurologic examination
- atypical headache features
- headaches that do not fulfill the strict definition of a primary headache disorder
In a patient who requires brain neuroimaging, which imaging modality is the primary choice?
1 - MRI
2 - ultrasound
3 - CT
4 - X-ray
1 - MRI
- with and without contrast
- head CT is more expeditious for evaluating those suspected of having acute intracranial hemorrhage.
In patients with infrequent (<1 day/month) or frequent (<15 days/month) tension headaches, what medications should they be advised to buy over the counter?
1 - aspirin
2 - codeine and aspirin
3 - morphine sulphate and aspirin
4 - paracetamol
1 - aspirin
- NSAIDs essentially
- can give a single dose of:
- Ibuprofen (400 to 600 mg)
- Naproxen sodium (220 to 550 mg)
- Aspirin (500 to 650 mg)
- Amitriptyline can be preventative
- acupuncture can help
What is typically the 1st line treatment patients with tension-type headaches are given as part of abortive approach?
1 - paracetamol
2 - lifestyle advice
3 - NSAIDs
4 - Triptan (serotonin agonist)
2 - lifestyle advice
- adequate sleep, hydration, exercise, cognitive behavioural therapy, biofeedback
If lifestyle advice fails in patients with tension-type headaches, which of the following can then be prescribed next as part of abortive approach?
1 - paracetamol
2 - aspirin
3 - NSAIDs
4 - Triptan (serotonin agonist)
1 - paracetamol
- aspirin and NSAIDs could be tried if paracetamol is ineffective
Should opioids ever be prescribed for the acute management of patients with tension-type headaches?
- no
What is typically the 1st line treatment patients with tension-type headaches are given as part of a preventative approach?
1 - Amitriptyline
2 - Lifestyle advice
3 - Propranolol
4 - Topiramate
2 - Lifestyle advice
If lifestyle advice fails in patients with tension-like headaches, which of the following can then be prescribed next as part of preventative approach?
1 - Amitriptyline
2 - Lifestyle advice
3 - Propranolol
4 - Paracetamol
1 - paracetamol
- aspirin and NSAIDs could be tried if paracetamol is ineffective
If lifestyle advice fails, paracetamol and/or NSAIDs fails in patients with tension-like headaches, which of the following can then be prescribed next as part of preventative approach?
1 - Amitriptyline
2 - Lifestyle advice
3 - Acupuncture
4 - Paracetamol
3 - Acupuncture
If lifestyle advice, paracetamol and/or NSAIDs and acupuncture fails in patients with tension-like headaches, which of the following can then be prescribed next as part of preventative approach?
1 - Amitriptyline
2 - Lifestyle advice
3 - Acupuncture
4 - Paracetamol
1 - Amitriptyline
- inhibits norepinephrine or serotonin transporter (NET or SERT) at presynaptic terminals
- means more serotonin and/or noradrenaline
Which of the following would be a suitable differential for a patient with suspected tension-type headaches?
1 - cluster headache/migraine
2 - cervical spondylosis
3 - intracranial pathology
4 - increased BP
5 - TIAs
6 - sinusitis/otitis media
7 - all of the above
7 - all of the above
