Tension Headache

Most common primary headache disorder with lifetime prevalence between 30-78%.

 ETIOLOGY/ PATHOGENESIS

  • More common in women than men.
  • Most often begins in second decade of life decreasing in prevalence with increasing age.
  • No specific underlying pathophysiological mechanism.

PERTINENT HISTORICAL FINDINGS/ CLINICAL SYMPTOMS

  • Occurs in episodic and chronic forms.
  • Pericranial muscle spasm may or may not be present in either form.
  • Episodic headache consists of recurrent attacks of tight, band-like, bilateral, mild to moderate head pain lasting from a few minutes to days.
  • Do not worsen with daily physical exertion and are not associated with nausea although photophobia and photophonia maybe presents.
  • In the chronic form, headaches occur 15 days per month.

PERTINENT PHYSICAL EXAM FINDINGS

  • No specific physical exam findings

DIFFERENTIAL DIAGNOSIS

  • Migraine Headache
  • Depression
  • Arteritis
  • Brain tumors/masses
  • Post-traumatic headache
  • Temporomandibular joint dysfunction
  • Sinusitis

DIAGNOSTIC EVALUATIONS

  • No specific laboratory tests or imaging studies are helpful except to ruleout other medical conditions.

MEDICAL MANAGEMENT

  • Episodic headaches: Analgesics: acetaminophen. NSAIDs: aspirin, ketoprofen, ibuprofen, naproxen
  • Chronic Headaches: prophalactic treatment with tricyclic antidepressants: amitriptyline, nortriptyline; doxepin, maprotiline, fluxetine.

SURGICAL MANAGEMENT (when applicable)

  • Not applicable

EMERGENCY MANAGEMENT (when applicable)

  • Not applicable

PATIENT EDUCATION/ MAINTENANCE – PREVENTION

  • Management of other health problems responsible for headaches.

17204 71485

Dr. Zachary Lahlou

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