Tension Headache

Key Facts

Most chronic daily & recurrent headaches are tension headaches

Epidemiology

Can be episodic (<15 days/month) or chronic (>15 days/ month for at least 3 months)

No organic cause

The COMMONEST PRIMARY HEADACHE

Aetiology

Hunger

Eyestrain

Bad posture

Anxiety

Sleep deprivation

Noise

Stress

Clinical Presentation

Not aggravated by physical activity

Tight band-like sensation

Without vomiting or sensitivity to head movement, no aura

Pressure behind eyes, mild-moderate pain

Usually as one of the following - bilateral, pressing/tight non-pulsatile, mild/moderate intensity, +/- scalp muscle tenderness

Headaches can last from 30 mins to 7 days

Episodic (<15 days/month) or chronic (>15 days a month for at least 3 months)

Not attributed to other disorder

Differential Diagnosis

Migraine, cluster headache, giant cell arteritis, drug-induced headache

Diagnosis

Clinical diagnosis from history

Treatment

Stress relief e.g massage or acupuncture

Symptomatic treatment for episodes occurring >2 days a week

Reassurance and lifestyle advice e.g. regular exercise, avoidance of triggers

NO OPIOIDS

Limit the use of analgesia to no more than 6 days a month to reduce chance of medication-overuse headache

NSAIDs

Consider tricyclic antidepressants

Paracetamol

Aspirin

Beware of medication-overuse headaches

Other causes are mixed analgesics e.g. paracetamol + opiates, ergotamine and triptans

Common reason for episodic headache becoming chronic daily headache

Worsens whilst on regular analgesia especially on OPIOIDS