Tension-Type-Headaches Flashcards
Primary headaches = no known cause
Secondary headaches = have a known cause
Which of these is more common?
- primary
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
Are tension like headaches pulsatile in nature?
- No
Pulsatile may suggest increases BP or increased intracranial pressure
Are tension like headaches characterised by pressing/tightening or stabbing pain?
- pressing/tightening
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
Other features are present in migraines and cluster headaches
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. Which of the following is NOT typically linked to causing medication overuse headaches?
1 - codeine
2 - cyclizine
3 - triptans
4 - NSAIDs
2 - cyclizine
All others are pain medications, except triptan which is specific for headaches
Cyclizine is used to reduce nausea and vomiting
When performing a history on a patient with a headache, if there is an increase in headache symptoms when performing a Valsalva manoeuvre bad?
- Yes
Indicates a space occupying lesion in cranial cavity
Causes an increased intracranial pressure
- 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
A RED FLAG here would be if the headache 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 gain
Weight loss is a red flag as it could be caused by malignancy
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
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, they should receive brain neuroimaging if they have how many of the following?
- unexplained abnormal finding on neurologic examination
- atypical headache features
- headaches that do not fulfil the strict definition of a primary headache disorder
1 - >1
2 - >2
3 - all 3
1 - >1
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.
Which of the following conditions has been linked with tension like headaches?
1 - strokes
2 - hypertension
3 - cervical spine arthritis
4 - aneurysms
3 - cervical spine arthritis
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, avoid caffiene and stress
Patients will also be advised to complete a headache diary
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
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 tension-like headaches are persistent despite other therapeutic approaches, which of the following can then be prescribed next as part of preventative approach as a prophylactic?
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
Patients can experience drowsy/hungover feeling
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
Migraines = feature full headaches
Tension like headaches = featureless headaches
This essentially means there are specific features associated with Migraines (aura, vomiting, photophobia etc..
When thinking about red flags, which of the following is most likely to cause a new severe or unexpected headache?
1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis
2 - sub-arachnoid haemorrhage
Also described as a thunderclap headache
When thinking about red flags, which of the following is most likely to follow a head trauma?
1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis
3 - subdural bleed
When thinking about red flags, which of the following is most likely to cause a headache in an immunocompromised patient?
1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis
1 - malignancy
When thinking about red flags, which of the following is most likely to cause a persistent headache that then changes drastically?
1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis
1 - malignancy
This is very common in >50s
When thinking about red flags, which of the following is most likely to cause a headache in a current or recent pregnancy?
1 - malignancy
2 - sub-arachnoid haemorrhage
3 - pre-eclampsia
4 - giant cell arteritis
3 - pre-eclampsia
When thinking about red flags, which of the following is most likely to cause a headache that is associated with pain, specifically in the temporal region?
1 - malignancy
2 - sub-arachnoid haemorrhage
3 - pre-eclampsia
4 - giant cell arteritis
4 - giant cell arteritis
