Tension-type headaches can be either episodic or chronic.
Stress and mental tension are common triggers.
Symptoms include dull, nonpulsatile, bilateral, constricting pain (not severe); pericranial tenderness is common.
Unlike migraine, there is no significant nausea, no vomiting, and a lack of aggravation by routine physical activity.
Usually responds to simple analgesics; preventive treatments have less evidence for their effectiveness.
Nondrug therapies include relaxation, electromyographic biofeedback, cognitive behavioral therapy, and physical therapy.
Tension-type headaches can be either episodic or chronic. They are rarely disabling or associated with any significant autonomic phenomena, thus patients do not usually seek medical care and usually successfully self-treat. The attacks are generalized throughout the head with a predilection for involving the frontal and occipital regions. The pain is typically expressed as being a "tight band" around the head. It does not worsen with routine physical activity.
History and exam
Key diagnostic factors
- generalized head pain
- frontal or occipital head pain
- nonpulsatile head pain
- constricting pain
- normal neurologic examination
Other diagnostic factors
- pericranial tenderness
- sternocleidomastoid muscle tenderness
- trapezius muscle tenderness
- temporalis muscle tenderness
- lateral pterygoid muscle tenderness
- masseter muscle tenderness
- photophobia or phonophobia
- regular analgesic use
- anxiety and depression
- mental tension
- missing meals
- female sex
- age 20-39 years
- lower socioeconomic status
- analgesic overuse
1st investigations to order
- clinical diagnosis
Investigations to consider
- CT sinus
- MRI brain
- lumbar puncture
chronic symptoms (>7-9 headache days/month)
- Chronic migraine
- Medication-overuse headache
- Sphenoid sinusitis
- Headaches in pregnancy and postpartum: ACOG clinical practice guideline No. 3
- ACR Appropriateness Criteria: headache
Tension-type headacheMore Patient leaflets
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