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Tension headache

Background knowledge ๐Ÿง 


  • Tension headache is a common type of headache characterized 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


  • 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 ๐ŸŒก๏ธ


  • 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


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

Investigations ๐Ÿงช


  • 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 ๐Ÿฅผ


  • 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-behavioral therapy for stress management


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


  • 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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