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:
- Assume SAH if first or worst
- Glaucoma (NB)
- Cluster, Migraine, Sinusitis
- SOL (e.g. SDH)
- Temporal arteritis (NB)
- Meningitis
- Otitis Media
- Medication overuse headache
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!)