Tension headache

Tension Headache Clinical Presentation

History

Pain onset in tension-type headache can have a throbbing quality and is usually more gradual than onset in migraines. Compared with migraines, tension-type headaches are more variable in duration, more constant in quality, and less severe.

IHS diagnostic criteria for tension-type headaches states that two of the following characteristics must be present^[8] :

·         Pressing or tightening (nonpulsatile quality)

·         Frontal-occipital location

·         Bilateral - Mild/moderate intensity

·         Not aggravated by physical activity

Tension-type headache history is as follows:

·         Duration of 30 minutes to 7 days

·         No nausea or vomiting (anorexia may occur)^[5]

·         Photophobia and/or phonophobia^[5]

·         Minimum of 10 previous headache episodes;^[5] fewer than 180 days per year with headache to be considered "infrequent"

·         Bilateral and occipitonuchal or bifrontal pain

·         Pain described as "fullness, tightness/squeezing, pressure," or "bandlike/viselike"

·         May occur acutely under emotional distress or intense worry

·         Insomnia

·         Often present upon rising or shortly thereafter

·         Muscular tightness or stiffness in neck, occipital, and frontal regions

·         Duration of more than 5 years in 75% of patients with chronic headaches

·         Difficulty concentrating

·         No prodrome

New headache onset in elderly patients should suggest etiologies other than tension headache.

Physical Examination

The physical examination serves mainly to exclude the possibility of other headache causes.

·         Vital signs should be normal.

·         Normal neurologic examination

·         Tenderness may be elicited in the scalp or neck, but no other positive physical exam findings should be noted.

·         Pain should not be elicited over temporal arteries or positive trigger zones.

·         Some patients with occipital tension headaches may be very tender when upper cervical muscles are palpated.

·         Pain associated with neck flexion and stretching of paracervical muscles must be distinguished from nuchal rigidity associated with meningeal irritation.

Medical Care

Non-pharmacological

Various modalities are used in the treatment of tension headaches. These include hot or cold packs, ultrasound, electrical stimulation, improvement of posture, trigger point injections, occipital nerve blocks, stretching, and relaxation techniques.

Regular exercise, stretching, balanced meals, and adequate sleep may be part of a headache treatment program.^[7] 

pharmacological

Tab. panadol and Nsaids can be given to patient .but drugs can also cause medication overuse headache.