#TTH2022
Tension-type headache is a primary headache disorder, which is the most prevalent neurological disorder world-wide. The diagnosis of tension-type headache is made based on criteria from the International Headache Classification of Headache Disorders (ICHD-3). ICHD-3 criteria for tension-type headache subdivides tension-type headache into 3 categories based on headache frequency: episodic tension-type headache (less than 1day/month on average or less than 12 days/year), frequent episodic tension-type headache (1-14 days/month or between 12 or more and less than 180 days/year), or chronic tension-type headache (headaches for 15 or more days a month or 180 or more days/year). Both types of episodic tension-type headache have a duration of 30 minutes to 7 days while chronic tension-type headache has a duration of hours to days or is unremitting.
Clinical features include at least 2 of the following 4 pain characteristics; bilateral location, pressing or tightening quality, mild or moderate intensity, not aggravated by routine physical activity. For those with episodic tension-type headache, there should be no nausea or vomiting associated with the headache, but they may have either photophobia or phonophobia, though this is not required. For those with chronic tension-type headache, they may have either photophobia, phonophobia, or mild nausea associated with headache.
The diagnosis of tension-type headache is reached by detailed history of patient symptoms and a normal neurological examination, and excluding secondary headaches . Use of diagnostic headache diary may help in diagnosis of tension-type headache. In the patient history, tension-type headaches are often described as long lasting, more often bilateral and pressure like in nature. Often described by patients like a “cap” around their head or a “band like” sensation. Some patients with tension-type headache may reports tenderness of head, neck and shoulder muscles. Triggers may exist for some patients, with stress being the most common followed by sleep changes . Despite tension-type headache being mild to moderate in intensity, up to 60% may describe impaired social activities and working ability.
It is important to note that while people with episodic tension-type headache rely mainly on home remedies and over the counter treatments for relief of symptoms, those with chronic tension-type headache are more disabled from symptoms and may seek medical attention. Special attention should be made to medication-overuse headache and other headache red flags that may indicate a secondary disorder. These include headaches that are sudden in onset, progressively worsening in time, brought on by sneezing/coughing or exercise, headaches brought on by head trauma, headaches associated with weight loss or change in memory or personality, headaches associated with focal neurological signs or symptoms, headaches starting in age greater than 50, headaches associated with a stiff neck or unexplained fever, headaches that worsened with change in position or Valsalva. If any headache red flags are present, consider neuroimaging to rule out a secondary disorder.
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