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Updated: Dec 18 2019

Tension Headache

  • Snapshot
    • A 28-year-old male lawyer presents with headache. He describes the headache as of tightening quality on both sides of his forehead. It is non-throbbing, but feels like a "tight cap." He denies phonophobia or photophobia. On physical exam, there is pericranial muscle tenderness.
  • Introduction
    • Most common type of headache
      • usually described as nonthrobbing
      • usually does not have associated features
    • Mean age ~ 30 years old
    • Mental tension and stress are important precipitating factors
      • however, these symptoms are just as frequent in migraine headache
  • Presentation
    • Symptoms
      • bilateral
        • "band-like," "tight cap"
      • nonthrobbing headache
      • not worsened by physical activity
      • uncommon to have phonophobia or photophobia
    • Physical symptoms
      • pericranial muscle tenderness
        • absence does not rule out diagnosis
  • Evaluation
    • Clinical diagnosis
  • Differential
    • Migraine headache
    • Medication overuse headache
    • Cluster headache
    • Secondary causes of headache
      • head injury
      • vascular disorder
      • infection
  • Treatment
    • Identify headache triggers
    • Acute therapy
      • NSAIDS (first-line)
      • acetaminophen (first-line)
    • Prophylactic therapy
      • amitriptyline (first-line prophylactic treatment)
  • Prognosis, Prevention, Complications
    • Prevention
      • prophylactic therapy
    • Complications
      • reduced productivity
      • functional impairment
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