Tension-type headache
小结
定义
病史和体格检查
关键诊断因素
- generalized head pain
- frontal or occipital head pain
- nonpulsatile head pain
- constricting pain
- normal neurologic examination
其他诊断因素
- pericranial tenderness
- sternocleidomastoid muscle tenderness
- trapezius muscle tenderness
- temporalis muscle tenderness
- lateral pterygoid muscle tenderness
- masseter muscle tenderness
- photophobia or phonophobia
- nausea
- regular analgesic use
- anxiety and depression
- somatization
危险因素
- mental tension
- stress
- missing meals
- fatigue
- lack of sleep
- somatization
- female sex
- age 20-39 years
- lower socioeconomic status
- analgesic overuse
诊断性检查
首要检查
- clinical diagnosis
需考虑的检查
- CT sinus
- MRI brain
- lumbar puncture
- polysomnography
治疗流程
acute attack
chronic symptoms (>7-9 headache days/month)
撰稿人
作者
Mark W. Green, MD, FAAN
Professor of Neurology, Anesthesiology and Rehabilitation Medicine
Emeritus Director of Headache and Pain Medicine
Icahn School of Medicine at Mount Sinai
New York
NY
Disclosures
MWG declares that he has no competing interests.
Rachel Colman, MD
Assistant Professor of Neurology
Icahn School of Medicine at Mount Sinai
New York
NY
Disclosures
RC declares that she has no competing interests.
Peer reviewers
Sait Ashina, MD
Assistant Professor of Neurology and Anesthesia
Harvard Medical School
Director of Comprehensive Headache Center
Beth Israel Deaconess Medical Centre
Boston
MA
Disclosures
SA has received honoraria from and is a consultant for Abbvie/Allergan, Eli Lilly, Linpharma, Lundbeck, Satsuma, Teva, Theranica, Percept, and Impel NeuroPharma. SA is an author of one of the references in this topic.
Giles Elrington, MBBS (Hons), MD, FRCP
Consultant Neurologist
Barts Health NHS Trust
London
UK
Disclosures
GE is involved in a number of clinical trials on multiple sclerosis sponsored by Genzyme, Roche, Teva, Novartis, Biogen, as well as one funded by the MRC. He is also involved in clinical trials sponsored by Allergan, NMT Medical, GlaxoSmithKline (GSK), Bristol-Myers, the UK's Parkinson's Disease Research Group, and Pharmacia. In addition, he has attended lectures, conferences, and symposia with the following companies: GSK, AstraZeneca, MSD, Almirall, Pfizer, Menarini, Allergan, Biogen, Teva, Conference Plus, Infomed, BMJ.
Paul Davies, MA, MD, FRCP
Consultant Neurologist
Northampton General Hospital
Northampton
UK
Disclosures
PD declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan 25;38(1):1-211.Full text
Ashina S, Mitsikostas DD, Lee MJ, et al. Tension-type headache. Nat Rev Dis Primers. 2021 Mar 25;7(1):24. Abstract
Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol. 2010 Nov;17(11):1318-25.Full text Abstract
Headaches in pregnancy and postpartum: ACOG clinical practice guideline No. 3. Obstet Gynecol. 2022 May 1;139(5):944-72. Abstract
Banzi R, Cusi C, Randazzo C, et al. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults. Cochrane Database Syst Rev. 2015;(5):CD011681.Full text Abstract
Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016;(4):CD007587.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Chronic migraine
- Medication overuse headache
- Sphenoid sinusitis
More 鉴别诊断指南
- Headaches in pregnancy and postpartum: ACOG clinical practice guideline No. 3
- ACR Appropriateness Criteria: headache
More 指南患者教育信息
Tension-type headache
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