Headaches: Tension

Question 1

Definition

Answer 1

Primary headache which classically produce a mild ache across the forehead and in a band-like pattern around the head = bilateral and radiates to neck. Tension headaches don’t produce visual changes.
- often last for several hours
- often recur daily

Question 2

Risk factors

Answer 2

Stress
Depression
Alcohol
Skipping meals
Dehydration

Question 3

Aetiology

Answer 3

Stress
Noise
Concentrated visual effort
Fumes / smells
There is little evidence for association with:
High BP
Refractive errors
Cervical spondylitis (inflammation of the vertebra)

Question 4

Pathophysiology

Answer 4

This may be due to muscle ache in the frontalis, temporalis and occipitalis muscles as well as neurovascular irritation

Question 5

Signs and Symptoms

Answer 5

Symptoms usually bilateral = RUBBER BAND TIGHT AROUND HEAD
Tight band sensation
Pressure behind the eyes
Can be across the whole top of the head, from occiputs to frontal region. Typically frontal, with or without radiation to the occiput
Typically occur frequently – can be daily
Does not wake patient from sleep – typical onset is after waking, often worse during the middle of the day
Not sensitive to head movement
No feeling of need to vomit
Generally – no neurological signs

Question 6

Diagnosis

Answer 6

Clinical from history
Requires each of the following
- Absence of n+v
- No aura symptoms
+ 2 of:
- Both sides affected
- Non-throbbing quality
- Moderate intensity
- No worsening during physical activity

Question 7

Treatment

Answer 7

Simple analgesia
- Aspirin
- Paracetamol
Avoid triggers