Tension Headache

Question 1

Define tension headache

Answer 1

The most common type of headache, which is considered a ‘normal, everyday headache’. Can be divided into:

• Episodic - occurs on < 15 days per month
• Chronic - occurs on > 15 days per month

Question 2

What are the causes/risk factor of tension headache?

Answer 2

The exact cause is unclear. They are primary headaches (i.e. they have no underlying cause). There are well-known triggers: 
• Stress/anxiety  
• Poor sleep  
• Dehydration 
• Bright sunlight  
• Squinting  
• Fatigue  
• Missing meals  
• Noise

Question 3

What are the symptoms of tension headache?

Answer 3

• described as a tight band around the head: Pressure/tightness around the head.
• Pain tends to be bilateral and non-pulsatile
• Can be disabling for a few hours but does not have specific associated symptoms (unlike migraines) –may have one of the migraine-associated symptoms e.g. photophobia but no more.
• Gradual onset and Variable duration
• Often triggered by something and is usually responsive to over-the-counter medication

Question 4

What are the signs of tension headache?

Answer 4

usually no signs with the exception of the occasional tenderness in cranial muscles

Question 5

What investigations are carried out for tension headache?

Answer 5

• Diagnosis is clinical, with no specific test required to confirm it.
• CT Sinuses - may be considered in cases of refractory or progressing headaches to exclude sphenoid sinusitis.
• MRI Brain - to exclude brain tumour
• Lumbar Puncture - to exclude infective causes, sinus venous thrombosis, or pseudotumor cerebri.

Question 6

What is the management of tension headache?

Answer 6

• Address triggers (e.g. stress, anxiety)
• Advice on avoiding medications that can cause medication-induced headaches (e.g. opioids)
• Simple analgesia (e.g. ibuprofen, paracetamol, aspirin)
• Tricyclic antidepressants may be considered in frequently recurrent episodic tension headaches or chronic tension headaches