Tension Headache



Background

  • Episodic, assoc. with stressful event.
  • Recurs daily often occipitofrontal.
  • Probably muscle contractions in scalp / neck ± psychological overtones
  • F > M. Any age but max in young adults.

Clinical

  • Headache of moderate intensity, bilateral, self-limited
  • Usually responds to non-prescription medication
  • Squeezing or pressing, constant "band", frontal then global
  • No associated red flags
  • No neurological aura / symptoms / vomiting
  • May be eased by physical activity
  • Neurological exam and fundii normal
  • Neck muscles may be tender
  • Temporal arteries normal

Differential Dx

The DDX is very broad but should include:


Investigations

  • Imaging ONLY if recent change in character or neuro findings
  • Consider ESR

Management

  • High flow oxygen
  • Advice
  • Regular exercise / relaxation
  • AVOID opiates (including Solpadol!)


Content By Dr. Íomhar O' Sullivan 24/09/2012. Last review Dr. ÍOS 22/02/13.