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Tension HeadacheAka: Occipital Headache

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  1. See Also
    1. Headache
    2. Headache Causes
    3. Acute Generalized Headache
    4. Acute Localized Headache
    5. Acute Recurrent Headache
    6. Chronic Progressive Headache
  2. Pathophysiology
    1. Pain associated with myofascial (muscular) cause
  3. Causes
    1. Stress or worry
    2. Anxiety
    3. Major Depression
    4. Overwork
    5. Lack of sleep
    6. Incorrect posture
    7. Marital and family dysfunction
    8. Post-Concussion (<3 months)
    9. Conversion
    10. Malingering
  4. Types
    1. Acute Tension Headache
    2. Chronic Tension Headache
      1. See Chronic Daily Headache
      2. Present at least half the days of the month
      3. Persists for 6 months or more
  5. Symptoms
    1. Characteristics
      1. Pressing, tightening or vice-like gripping Headache
    2. Location
      1. Band of pain extending from forehead back to occiput
      2. Usually affects bilateral forehead
      3. Radiation into trapezius muscle and posterior neck
    3. Timing
      1. Mild to moderate intensity for more than 30 minutes
    4. Provocative
      1. Not provoked by low level activity
    5. Migraine Headache symptoms absent
      1. No Nausea or Vomiting
      2. No photophobia and phonophobia
      3. Headache is not pulsating
  6. Evaluation
    1. See Headache History
    2. See Headache Examination
    3. See Headache Diagnostic Testing
  7. Management: General Measures
    1. See Nonpharmacologic Headache Treatment
    2. Reassurance
    3. Tobacco Cessation
      1. Headache is related to amount of Tobacco used
      2. Headaches increase with Cigarette use per day
    4. Modify or eliminate stressors
    5. Biofeedback
    6. Relaxation therapy
    7. Yoga
    8. Coping strategies
    9. Counseling (Psychotherapy)
    10. Acupuncture
      1. Vickers (2004) BMJ 328:744
    11. Spinal Manipulation
    12. Physical Therapy
      1. Hammill (1996) {a 14377} 36:149
  8. Management: Medications
    1. Trigger Point Injection at affected occiput
    2. Selective C1-C2 lateral Joint Injection
      1. Aprill (2002) Cephalalgia 22:15
    3. Analgesics
      1. Tylenol
      2. NSAIDs
      3. Aspirin
      4. Avoid Narcotics
    4. Consider Antidepressants for Headache prophylaxis
      1. Tricyclic Antidepressants (e.g. Amitriptyline)
        1. Gobel (1994) Pain 59:241
      2. Selective Serotonin Reuptake Inhibitors (SSRI)
        1. Adelman (2000) {a 14377} 40:572
  9. References
    1. Millea (2002) Am Fam Physician 66(5):797
    2. Redillas (2000) {a 14377} 40(2):83
    3. Ryan (1996) Am Fam Physician 54(3):1051
    4. Stevens (1993) Am Fam Physician 47(4):799
    5. Trachtenbarg (1994) Postgrad Med 95(6):44

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