0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22
1408 Tension-Type Headache
TENSION-TYPE HEADACHE
CHAD CHRISTINE, MD
history & physical
■Recurrent headache disorder
■Pressing/tightening (nonpulsatile) holocephalic pain of mild to
moderate severity
■Contraction of neck & scalp muscles common
■Develops over minutes to hours
■May occur daily
■Absence of nausea, vomiting, photophobia, phonophobia
■Normal exam
tests
■Diagnosis made clinically
■Lab tests & brain imaging are normal
■Lumbar puncture opening pressure & CSF studies are normal
differential diagnosis
■Brain mass lesion & subdural hematoma excluded by history & brain
imaging
■Migraine headache distinguished by history
■Pseudotumor cerebri, postconcussion syndrome, metabolic disor-
ders (eg, hypothyroidism) excluded by history & serum studies
■Dental pathology, sinus disease, poor posture or unphysiologic work
conditions, inadequate sleep, sleep apnea, depression excluded clin-
ically
■Brain imaging indicated for prominent change in headache quality
or frequency
management
■Depends on severity & prior treatment
■General measures
➣Headache diary may elucidate precipitants
➣Ensure adequate relaxation, exercise & sleep
specific therapy
Indications
■Abortive meds indicated for rare headaches (2 or fewer a week);
prophylactic meds are used for more frequent moderate to severe
headaches