Tension headache overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]
Overview
A common primary headache disorder, characterized by a dull, non-pulsatile, diffuse, band-like (or vice-like) pain of mild to moderate intensity in the head, scalp or neck. The subtypes are classified by frequency and severity of symptoms. There is no clear cause even though it has been associated with muscle contraction and stress.
Historical Perspective
Tension headaches, which were renamed tension-type headaches by the International Headache Society in 1988, are the most common type of primary headaches.
Classification
Tension-type headaches can be episodic or chronic. Episodic tension-type headaches are defined as tension-type headaches occurring less than 15 days a month, whereas chronic tension headaches occur 15 days or more a month for at least 6 months. Tension-type headaches can last from minutes to days or even months, though a typical tension headache lasts 4-6 hours.
Causes
The exact cause of tension-type headaches is still unknown.
Epidemiology and Demographics
Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of population suffers from chronic-tension type headache.
Natural History, Complications and Prognosis
Tension headaches that do not occur as a symptom of another condition may be painful, but are not harmful. It is usually possible to receive relief from treatment. Tension headaches that occur as a symptom of another condition are usually relieved when the underlying condition is treated. Frequent use of pain medications in patients with tension-type headache may lead to the development of medication overuse headache or rebound headache.
Diagnosis
History and Symptoms
Tension-type headache pain is often described as a constant pressure, as if the head were being squeezed in a vise. The pain is frequently bilateral which means it is present on both sides of the head at once. Tension-type headache pain is typically mild to moderate, but may be severe. In contrast to migraine, the pain does not increase during exercise.
Physical Examination
Laboratory Findings
CT
MRI
Treatment
Medical Therapy
Episodic tension-type headaches generally respond well to over-the-counter analgesics, such as paracetamol, ibuprofen or aspirin. Simple analgesic monotherapy such as NSAIDS or aspirin are recommended (Grade 1A) for episodic TTH treatment requiring patients. Simple analgesic monotherapy is used in combination with caffeine for TTH patients who are unresponsive or have a poor response to analgesic monotherapy (Grdae 2A). Combination therapies including opioids or butalbital are not recommended as first line agents for TTH Rx (Grade 1C). Inpatient treatment for severe TTH can be treated in addition to the above mentioned treatment with chlorpromazine, metoclopramide, combination of metoclopramide and diphenhydramine and intramuscular ketorolac.