Has at least two of the following characteristics:
- mild to moderate in severity
- often felt as a pressure or constriction
- not accompanied by significant systemic upset or neurological deficits
- not aggravated by routine physical activity
Episodes last from 30 minutes to 7 days. Nausea or vomiting does not occur but can have photophobia or phonophobia. Cause of the headache cannot be attributed to another disease e.g. - post trauma, brain tumours, neck pathology etc
The following general measures may help in the management of tension-type headaches:
- avoid: overwork & stress, excess alcohol, lack of exercise
- clinical depression should be treated
avoid analgesic abuse:
- a maximum of 12 analgesic doses per week should be allowed
- withdrawal of analgesics may cause rebound symptoms for up to 14 days
- keeping a headache diary to help in the diagnosis and management
- physiotherapy/massage – specially for musculoskeletal symptoms
- strategies to counteract stress – relaxant,CBT, NB:reassurance
Drugs in tension type headaches can either be used for acute episodes or for prophylaxis
Episodic tension headaches happening on fewer than 2 days per week can be treated symptomatically with over the counter analgesics. The drug treatment of episodic tension-type headaches consists of:
- paracetamol - appears to be less effective
- NSAID or aspirin >16yrs. Codeine and dihydrocodeine should be avoided.
NB: beware of medication overuse headaches. Episodic tension headaches occurring for >2 days per week trial of prophylaxis needed:
- tricyclic antidepressants: amitriptyline 10-25mg or Propranolol 40-160mg, minimum 3 months
- A course of acupuncture is now recommended by NICE
Referral: Neurology if failure of trial of treatment and prophylaxis, uncertainty of diagnosis, no improvement with withdrawal of analgesia for 3 weeks if suspected overuse.
Neurology suggest www.bash.org.uk publications, headache guidelines for further information.