Tension headache

Definition

• 1. Headache lasting from 30 min to 7 d
• 2. Headache has at least two of the following characteristics:
  • a. Bilateral location
  • Pressure or tightening (nonpulsating quality)
  • Mild or moderate intensity
  • Not aggravated by routine physical activity such as walking
• 3. Both of the following:
  • a. No nausea or vomiting (anorexia may occur)
  • b. No more than one of photophobia or phonophobia
• 4. Not attributed to another disorder

Differential Diagnosis

Headache

Common

• Migraine headache
• Tension headache
• Cluster headache

Killers

• Meningitis/encephalitis
  • Neoplastic meningitis
• Myocardial ischemia
• Retropharyngeal abscess
• Intracranial Hemorrhage (ICH)
  • SAH / sentinel bleed
• Acute obstructive hydrocephalus
• Space occupying lesions
• CVA
• Carbon monoxide poisoning
• Basilar artery dissection
• Preeclampsia
• Cerebral venous thrombosis
• Hypertensive emergency
• Depression

Maimers

• Giant cell arteritis of temporal artery (temporal arteritis)
• Idiopathic intracranial hypertension (Pseudotumor Cerebri)
• Acute Glaucoma
• Acute sinusitis
• Cavernous sinus thrombosis or cerebral sinus thrombosis
• Carotid artery dissection

Others

• Mild traumatic brain injury
• Trigeminal neuralgia
• TMJ pain
• Post-lumbar puncture headache
• Dehydration
• Analgesia abuse
• Various ocular and dental problems
• Herpes zoster ophthalmicus
• Herpes zoster oticus
• Cryptococcosis
• Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
• Ophthalmoplegic migraine
• Superior Vena Cava Syndrome

Aseptic Meningitis

• Viral
  • Varicella
  • Herpes
  • Enterovirus
  • West Nile
• Tuberculosis
• Lyme disease
• Syphilis
• Leptospirosis
• Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
• Noninfectious
  • Sarcoidosis
  • Vasculitis
  • Connective tissue disease
  • Drug induced aseptic meningitis

Treatment

• NSAIDs
• Consider treating severe tension HA like a migraine HA (can be difficult to distinguish)

Disposition

• Outpatient

See Also

• Headache
• Migraine Headache
• Cluster Headache

Source

• Tintinalli
• International Headache Society Diagnostic Criteria