19th June 2023

Tension-type Headache

Diagnosis

Tension headache is the most common primary headache disorder.

Clinical features include:

• Generalised (or more rarely unilateral) headache, often described as a ‘band-like’ tightness around the head. It can seem to originate from, or spread to, the neck.
• Mild to moderate intensity headache lasting minutes to days. It does not tend to be exacerbated by routine physical activities.
• Common triggers or exacerbating factors include stress, caffeine intake, and disturbed sleep.
• On examination, pericranial tenderness to touch may be present.
• Tension headaches can be classified into different types depending on the frequency of episodes:
  • Infrequent (<1 episode/month)
  • Frequent (episodes 1-14 days/month for >3 months)
  • Chronic (15 days or more/month for >3 months)
• Tension headaches may be associated with photophobia or phonophobia. Nausea and vomiting are not common features.

Management

Treatment of tension-type headaches includes:

• Avoidance of triggers or exacerbating factors, e.g. caffeine excess
• Simple analgesia e.g. paracetamol, aspirin, NSAIDs. However, caution not to overuse as it could lead to medication overuse headache.
• Avoidance of opioids
• Management of associated comorbidities such as mood disorders, chronic pain, and sleep disorders.

Prophylaxis of tension-type headache

Prophylaxis is indicated if chronic features and includes:

• Non-pharmacological, e.g. acupuncture
• Pharmacological options include a trial of low dose amitriptyline (off label use)