Internal Medicine

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