tension headache (stress headache)
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Etiology
- tiredness
- anorexia
- psychosocial stress
- pericranial muscle tension/tenderness
- analgesia abuse
- cutaneous allodynia[8]
Epidemiology
- common
Clinical manifestations
- typically described as bilateral, dull, constant pain in a band like distribution
- pressure or tight quality
- trigger points common[6] (bilateral)
- right upper trapezius
- sternocleidomastoid
- temporalis muscle
- abnormal forward head posture common[6]
- duration 3 minutes to 7 days[8]
- generally not disabling, does not prohibit activity
- not associated with nausea[8]
- may be associated with photophobia or phonophobia, but not both[13]
Diagnostic criteria
- at least 10 headaches fulfilling criteria*
- headaches (untreated or unsuccessfully treated) lasting 30 minutes to 7 days
- headaches with at least 2 of the 4 following characteristics
- bilateral
- pressing/tightening (tension) & non-pulsating
- mild to moderate severity
- not aggravated by routine physical activity
- walking, climbing stairs
- headache without nausea/vomiting
- no more than 1 episode of photophobia or phonophobia per headache
- not accounted for by more likely diagnosis[8]
* International Headache Society criteria
Radiology
- neuroimaging not indicated[8]
Complications
- little of no disability
- unlike migraine with aura, not associated with increased risk of stroke (see migraine)
Differential diagnosis
- chronic tension headaches may share characteristics of migraine headache thus the term 'mixed tension-vascular headache'
Management
- conservative measures
- warm/cold compresses
- stress reduction
- exercise
- drug reduction (post analgesic syndrome)
- biofeedback
- relaxation therapy
- cognitive behavioral therapy[8]
- pharmacologic agents
- acetaminophen 325-650 mg every 4-6 hours PRN
- NSAIDs
- caffeine-containing compounds[8]
- not indicated:
- tramadol
- isometheptene compounds
- barbiturates when other treatment options have failed[12]
- chronic headache (prophylaxis)
- cognitive behavioral therapy[8]
- antidepressants
- amitriptyline 25-50 mg QHS
- tricyclic antidepressants more useful than SSRI in patients with migraine or tension headaches[9]
- gabapentin, titrate up to 2400 mg QD[3]
- mirtazapine may be useful in patients without depression[4]
- acupuncture benefit may be due to placebo effect[5]
- no benefit of prophylaxis[11]
- no strong recommendations[14]
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1028-31
- ↑ Kaiser Permanente Videoconference, 9/9/99, Fresno, CA
- ↑ Jump up to: 3.0 3.1 Journal Watch 24(3):23, 2004 Spira PJ et al Gabapentin in the prophylaxis of chronic daily headache: a randomized, placebo-controlled study. Neurology 61:1753, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14694042 Silberstein SD, Neurology 61:1637, 2003
- ↑ Jump up to: 4.0 4.1 Journal Watch 24(14):116, 2004 Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology. 2004 May 25;62(10):1706-11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15159466
- ↑ Jump up to: 5.0 5.1 Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes M, Hummelsberger J, Irnich D, Weidenhammer W, Willich SN, Linde K. Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ. 2005 Aug 13;331(7513):376-82. Epub 2005 Jul 29. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16055451
- ↑ Jump up to: 6.0 6.1 6.2 Fernandez de-las-Penas C et al, Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache 2006, 46:1264 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16942471
- ↑ Bigal ME, Ashina S, Burstein R, Reed ML, Buse D, Serrano D, Lipton RB; AMPP Group. Prevalence and characteristics of allodynia in headache sufferers: a population study. Neurology. 2008 Apr 22;70(17):1525-33. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18427069
- ↑ Jump up to: 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Jump up to: 9.0 9.1 Jackson JL et al. Tricyclic antidepressants and headaches: Systematic review and meta-analysis. BMJ 2010 Oct 20; 341:c5222 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20961988 <Internet> http://www.bmj.com/content/341/bmj.c5222/T5.expansion
- ↑ Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008 Jan;7(1):70-83. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18093564
- ↑ Jump up to: 11.0 11.1 Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW. Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review. Fam Pract. 2010 Apr;27(2):151-65 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20028727
- ↑ Jump up to: 12.0 12.1 Windle ML Rapid Rx Quiz: Headache Medications Medscape. Sept 12, 2022 https://reference.medscape.com/viewarticle/980181
Blanda M, Taylor JP Tension Headache Medscape, Nov 16, 2022 https://emedicine.medscape.com/article/792384-overview - ↑ Jump up to: 13.0 13.1 NEJM Knowledge+ Neurology
- ↑ Jump up to: 14.0 14.1 Sico JJ, Antonovich NM, Ballard-Hernandez J et al 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Management of Headache. Ann Intern Med. 2024 Oct 29. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39467289