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  • Tension Headache

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Tension Headache

Aka: Tension Headache, Occipital Headache
  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. Diagnosis
    1. Characteristics: All must be present
      1. Headache lasts 30 minutes to 7 days
      2. No Nausea or Vomiting (although anorexia may be present)
      3. Photophobia or phonophobia
      4. Headache has at least 2 of the following features
        1. Bilateral distribution
        2. Pressing or tightening (non-pulsating quality)
        3. Mild to moderate intensity
        4. Not worse with routine Physical Activity (e.g. walking, climbing stairs)
    2. Timing
      1. Infrequent
        1. Ten episodes or more and
        2. Episodes occur <1 day per month on average (<12 per year)
      2. Frequent
        1. Ten episodes or more and
        2. Episodes occur 1-15 days per month for at least 3 months
  8. 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 [PubMed] (or open in [QxMD Read])
    11. Spinal Manipulation
    12. Physical Therapy
      1. Hammill (1996) Headache 36:149-53 [PubMed] (or open in [QxMD Read])
  9. Management: Medications
    1. Myofascial injections
      1. Trigger Point Injection at affected occiput or
      2. Lower Cervical Intramuscular Injection
    2. Selective C1-C2 lateral Joint Injection
      1. Aprill (2002) Cephalalgia 22:15-22 [PubMed] (or open in [QxMD Read])
    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 59:241-9 [PubMed] (or open in [QxMD Read])
      2. Selective Serotonin Reuptake Inhibitors (SSRI)
        1. Adelman (2000) Headache 40:572-80 [PubMed] (or open in [QxMD Read])
  10. References
    1. Millea (2002) Am Fam Physician 66(5):797-805 [PubMed] (or open in [QxMD Read])
    2. Redillas (2000) Headache 40(2): 83-102 [PubMed] (or open in [QxMD Read])
    3. Ryan (1996) Am Fam Physician 54(3):1051-7 [PubMed] (or open in [QxMD Read])
    4. Stevens (1993) Am Fam Physician 47(4):799-804 [PubMed] (or open in [QxMD Read])
    5. Trachtenbarg (1994) Postgrad Med 95(6):44-56 [PubMed] (or open in [QxMD Read])
    6. Hainer (2013) Am Fam Physician 87(10): 682-7 [PubMed] (or open in [QxMD Read])

Tension Headache (C0033893)

Definition (MSH) A common primary headache disorder, characterized by a dull, non-pulsatile, diffuse, band-like (or vice-like) PAIN of mild to moderate intensity in the HEAD; SCALP; or NECK. The subtypes are classified by frequency and severity of symptoms. There is no clear cause even though it has been associated with MUSCLE CONTRACTION and stress. (International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004: suppl 1)
Concepts Disease or Syndrome (T047)
MSH D018781
ICD9 339.1, 339.10, 307.81
ICD10 G44.2, G44.209, G44.20
SnomedCT 154931007, 193035000, 66551002, 398057008, 192028000, 230469006
English HEADACHE, PSYCHOGENIC, HEADACHE, TENSION, Headache, Tension, Headache, Tension-Type, Headaches, Tension, Headaches, Tension-Type, MUSCLE TENSION HEADACHE, PSYCHOGENIC CEPHALALGIA, TENSION HEADACHE, Tension Headache, Tension Headaches, Tension Type Headache, Tension-Type Headaches, Muscle contraction headache syndrome, tension-type headache (diagnosis), tension-type headache, tension headaches, Tension type headache, Tension type headache, unspecified, Headache tension, Tension headaches, HEADACHE TENSION, Headache, Stress, Headaches, Stress, Stress Headache, Stress Headaches, Tension headache NOS, Tension-type headache, unspecified, Tension-Type Headache [Disease/Finding], headaches tensions, headaches tension, muscle tension headache, stress headache, stress headaches, tension-type headaches, Headache;tension, headache tension, headaches muscle tension, tension type headache, headache stress, headaches stress, headaches tension type, headaches tension-type, Psychogenic headache, Tension headache, Tension-type headache, Stress headache, Psychogenic headache (finding), Tension-type headache (disorder), tension headache, headache; tension, tension; headache, Tension-Type Headache, Headache, Psychogenic, Headaches, Psychogenic, Psychogenic Headache, Psychogenic Headaches, Headache, Idiopathic, Headaches, Idiopathic, Idiopathic Headaches, Idiopathic Headache
Spanish cefalea de tipo tensional, Cefaleas de tensión, Tension-type headache, Tension headache, Cefalea a tension, Cefalalgia de Tipo Tensional, Cefalea debida a Tension, Cefalea debida a Tensión, Cefalea de Tipo Tensional, cefalea de tipo tensional (trastorno), cefalea por tensión, cefalea psicógena (hallazgo), cefalea psicógena, cefalea tensional (trastorno), cefalea tensional, dolor de cabeza psicógeno, Cefalea de tensión, Cefalea Psicogénica, Dolor de Cabeza Tensional, Cefalea Psicogenica
Italian Cefalea muscolotensiva, Cefalee muscolotensive, Cefalea idiopatica, Cefalea psicogenica, Cefalea da stress, Mal di testa da stress, Cefalea muscolo-tensiva, Cefalea tensiva
Dutch spanningshoofdpijnen, hoofdpijn; spanning, spanning; hoofdpijn, spanningshoofdpijn, Spanningshoofdpijn, Hoofdpijn, spannings-, Stresshoofdpijn
French Céphalées de tension, Cephalees de tension, Céphalée de tension, Céphalée par tension nerveuse, Céphalée psychogène
German Spannungskopfschmerzen, Spannungskopfschmerz, Kopfschmerz, Spannungs-, Kopfschmerz durch Streß
Portuguese Cefaleias tipo tensão, Cefaleia de tensão, Cefaleia de tensao, Cefaleias de tensão, Cefaléia Psicogênica, Cefaléia Tensional, Cefaléia Tensional Vascular, Cefalalgia Psicogênica, Cefalalgia Tensional, Cefalalgia do Tipo Tensional, Cefalgia Psicogênica, Cefalgia Tensional, Cefalgia do Tipo Tensional, Cefaléia do Tipo Tensional, Cefaléia por Estresse
Swedish Spänningshuvudvärk, SPANNINGSHUVUDVARK
Japanese キンチョウセイズツウ, 筋収縮性頭痛, 緊張性頭痛, 頭痛-筋緊張性, 筋緊張性頭痛, 頭痛-緊張性
Czech idiopatická bolest hlavy, hlava - bolest tenzní, hlava - bolest tenzního typu, psychogenní bolest hlavy, stresová bolest hlavy, hlava - bolesti tenzního typu, Tenzní typ bolesti hlavy, Bolest hlavy tenzní, Tenzní bolesti hlavy
Finnish Jännityspäänsärky, LIHASJANNITYSPAANSARKY
Danish Spaendingshovedpine
Hungarian tensios fejfajas, Tensiós fejfájás, Tensiós fejfájások, Fejfájás tensiós
Korean 긴장형 두통
Polish Ból głowy napięciowy, Ból głowy spowodowany ze stresem, Napięciowy ból głowy
Derived from the NIH UMLS (Unified Medical Language System)

Occipital headache (C0231613)

Concepts Sign or Symptom (T184)
SnomedCT 139574005, 330007
English HEADACHE, OCCIPITAL, Headache Occipital, headache at back of head (occipital), occipital headache (symptom), occipital headache, Headache, occipital, headaches occipital, Occipital headache, Occipital headache (finding)
Dutch occipitale hoofdpijn
French Mal de tête occipital
German okzipitaler Kopfschmerz
Italian Cefalea occipitale
Portuguese Cefaleia occipital
Spanish Dolor de cabeza occipital, Occipital headache, cefalea occipital (hallazgo), cefalea occipital, dolor de cabeza occipital
Japanese 後頭部痛, コウトウブツウ
Czech Týlní bolest hlavy
Hungarian Occipitalis fejfájás
Derived from the NIH UMLS (Unified Medical Language System)

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