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Tension headache

Medicine > Neurosciences

Background knowledge 🧠

Definition

  • Tension headache is a common type of headache characterised by bilateral, non-pulsating pain.
  • Often described as a feeling of tightness or pressure around the head.
  • Pain is typically mild to moderate in intensity.

Epidemiology

  • Most common type of primary headache.
  • Affects up to 78% of the population at some point in their lives.
  • More prevalent in women than men.
  • Onset typically in adolescence or young adulthood.

Aetiology and Pathophysiology

  • Exact cause is unknown.
  • Believed to involve muscle tension and stress.
  • Potential role of central nervous system dysregulation.
  • Triggers include stress, anxiety, poor posture, and lack of sleep.

Clinical Features 🌡️

Symptoms

  • Bilateral head pain.
  • Dull, aching pressure or tightness.
  • Pain may radiate to neck and shoulders.
  • Mild to moderate intensity.
  • No nausea or vomiting.
  • Not aggravated by routine physical activity.

Signs

  • Pericranial muscle tenderness.
  • Normal neurological examination.
  • No focal neurological signs.
  • Absence of photophobia and phonophobia (or mild if present).
  • Normal mental status.

Investigations 🧪

Tests

  • Diagnosis is primarily clinical.
  • Consider neuroimaging if atypical features or red flags are present.
  • Assess for secondary causes of headache if indicated.
  • No specific laboratory tests required.

Management 🥼

Management

  • Simple analgesics (e.g., paracetamol, ibuprofen).
  • Lifestyle modifications (stress management, regular exercise, adequate sleep).
  • Avoid overuse of analgesics to prevent medication overuse headache.
  • Physiotherapy for muscle tension.
  • Consider tricyclic antidepressants (e.g., amitriptyline) for chronic tension headache.
  • Cognitive-behavioural therapy for stress management.

Complications

  • Medication overuse headache.
  • Impact on quality of life.
  • Chronic daily headache.
  • Increased risk of anxiety and depression.

Prognosis

  • Generally good with appropriate management.
  • Chronic tension headache may require long-term management.
  • Lifestyle modifications can significantly improve outcomes.
  • Multidisciplinary approach can be beneficial.

Key Points

  • Tension headache is the most common type of headache.
  • Management includes simple analgesics and lifestyle changes.
  • Important to differentiate from other types of headaches.
  • Chronic cases may require preventive treatment.
  • Education and reassurance are crucial for effective management.

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Neurosciences