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