- 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.
- 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
The DDX is very broad but should include:
- Imaging ONLY if recent change in character or neuro findings
- Consider ESR
- High flow oxygen
- Regular exercise / relaxation
- AVOID opiates (including Solpadol!)