Tension Headache

Question 1

Definition

Answer 1

• The most common type of headache, which is considered a ‘normal, everyday headache’.

• Can be divided into:
o Episodic - occurs on < 15 days per month
o Chronic - occurs on > 15 days per month

Question 2

Aetiology

Answer 2

• The exact cause is unclear

* They are primary headaches (i.e. they have no underlying cause)

Question 3

Triggers

Answer 3

o Stress/anxiety
o Squinting
o Poor posture
o Fatigue
o Dehydration
o Missing meals
o Bright sunlight
o Noise

Question 4

Epidemiology

Answer 4

• MOST COMMON type of headache
• More common in WOMEN
• Most common in YOUNG ADULTS
• Most people will experience a tension headache at some point in their lives

Question 5

Presenting symptoms and signs on physical examination

Answer 5

• Mild-moderate in severity
• Pressure/tightness around the head like a tight band
• Pain tends to be bilateral
• Often a relationship with the neck
• Can be disabling for a few hours but does not have specific associated symptoms (unlike migraines)
• Gradual onset
• Variable duration
• Usually responsive to over-the-counter medication
• IMPORTANT: check for possible triggers when taking history (e.g. stress)
• Examination is usually NORMAL

Question 6

Investigations

Answer 6

NO investigations necessary

Question 7

Management plan

Answer 7

• Episodic Tension Headaches

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

Question 8

Possible complications

Answer 8

NONE

Question 9

Prognosis

Answer 9

• GOOD
• Not very severe or disabling
• Recurs