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Internal Medicine

Tension-type headache (TTH)

Recurrent episodes of headache lasting minutes to weeks.

  • M/C type of primary headache (69%)

Classification

  • Infrequent episodic TTH
    • Associated with pericranial tenderness
    • Not associated with pericranial tenderness
  • Frequent episodic TTH
    • Associated with pericranial tenderness
    • Not associated with pericranial tenderness
  • Chronic TTH
    • Associated with pericranial tenderness
    • Not associated with pericranial tenderness
aian-15-83-g002
Frequency characterization of tension type headaches | Chowdhury D. (2012). Tension type headache. Annals of Indian Academy of Neurology, 15(Suppl 1), S83–S88. doi:10.4103/0972-2327.100023

Aetiology

  • ♀ >> ♂

Precipitating factors:

  • Stress
  • Lack of sleep
  • Not eating on time

Clinical features

Headache:

  • Pressing/tightening in quality
  • Mild-to-moderate intensity
  • Bilateral in location
  • Does not worsen with the routine physical activity (and does not stop daily activities)
  • Associated features:
    • Photophobia/phonophobia present
    • Nausea & vomiting usually absent
    • No sleep disturbances
smj-59-399-g003
Primary headache disorders. | Lee, V., Ang, L. L., Soon, D., Ong, J., & Loh, V. (2018). The adult patient with headache. Singapore medical journal, 59(8), 399–406. doi:10.11622/smedj.2018094
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Patient with tension-type headache indicating location of his headache pain | Loder, E., & Rizzoli, P. (2008). Tension-type headache. BMJ (Clinical research ed.), 336(7635), 88–92. doi:10.1136/bmj.39412.705868.AD

 

Diagnosis

International Classification of Headache Disorders (ICHD-3) criteria:

smj-59-399-g004
ICHD-3 diagnostic criteria for tension-type headaches, migraines and cluster headaches. | Lee, V., Ang, L. L., Soon, D., Ong, J., & Loh, V. (2018). The adult patient with headache. Singapore medical journal, 59(8), 399–406. doi:10.11622/smedj.2018094

Fundal examination:

  • Papilloedema

Management

Non-pharmacological management:

  • Physical therapy (M/C):
    • Improvement of posture
    • Relaxation
    • Exercise programs
    • Hot and cold packs
    • Ultrasound, and electrical stimulation
    • Craniocervical training
  • Psychologic therapy:
    • Relaxation training
    • EMG biofeedback
    • Cognitive-behavioural therapy (CBT)

Pharmacotherapy:

  • Acute TTH: Analgesics and NSAIDSs (mainstays in acute therapy)
  • Chronic TTH: Amitriptyline (tricyclic antidepressant): M/effective

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