Name
TENSION HEADACHE
DESCRIPTION
DETAIL
DIFFERENTIAL DIAGNOSIS β’ Cervical spondylosis β’ TMJ syndrome β’ Caffeine-dependency β’ Non-prescription analgesic dependency β’ Depression β’ Head injury β’ Severe anemia or polycythemia β’ Uremia and hepatic disorders β’ Toxic effects from drugs or fumes β’ Dental disease β’ Paget disease of bone β’ Chronic sinusitis β’ Refractive error β’ Hypertension β’ Hypoxia β’ Temporal arteritis β’ Migraine β’ Lesions of the eye or middle ear β’ Lesions of the oral cavity -------------------------------------------------------------------------- CAUSES β’ Poor posture β’ Stress and/or anxiety β’ Depression (found in 70% of those with daily headache) β’ Low platelet serotonin β’ Cervical osteoarthritis β’ Intramuscular vasoconstrictionβ’ CBC β’ SMAC-20 β’ Thyroid studies β’ ESR in anyone over 50 years of age IMAGING β’ X-rays of cervical spine β’ Head CT or MRI necessary only when headache pattern has recently changed or there is a positive finding on neurological exam
TYPENOTES
RISK FACTORS : Obstructive sleep apnea, Medications, Excess caffeineGENERAL MEASURES o Relief measures - use relaxation routines; rest in quiet, dark room with cold washcloth over eyes; hot bath or shower; massaging back of neck and temples o Biofeedback training offers a nonpharmacologic alternative which is often beneficial ACTIVITY Encourage physical fitness, range of motion and strengthening exercises for the neck DIET No demonstrated link between diet and tension Headache PATIENT EDUCATION o Life style changes to minimize stress. Suggest patient seek counseling, if appropriate. o Encourage relaxation techniques, aerobic exercise, assertiveness training DRUG(S) OF CHOICE o Acute attack: non-steroidal anti-infl ammatory drugs (NSAIDs): ? Naproxen sodium (Naprosyn, Aleve) 500 mg/bid ? Fenoprofen calcium (Nalfon) 600 mg/day (200 mg q 4-6 hours) ? Ibuprofen (Motrin, Advil) 400 mg/tid ? Ketoprofen (Orudis) 50 mg/tid o Prophylaxis for chronic tension headache - antidepressants ? Amitriptyline (Elavil) 50-100 mg/day ? Desipramine (Norpramin) 50-100 mg/day ? Imipramine (Tofranil) 50-100 mg/day ? Nortriptyline (Pamelor) 25-50 mg/day ALTERNATIVE DRUGS o Beta blockers - prophylaxis (select one): ? Propranolol (Inderal LA) 80 mg/daily ? Nadolol (Corgard) 40 mg/daily ? Atenolol (Tenormin) 50-100 mg/daily o Combination agent - prophylaxis ? Isometheptene - dichloralphenazone - acetaminophen (Midrin) one capsule tid o Other NSAIDs PATIENT MONITORING A warm, nonjudgmental, understanding relationship with the physician is the best predictor for a successful treatment program PREVENTION/AVOIDANCE o Physical therapy o Biofeedback and relaxation therapy o Cervical traction o Injection of trigger points POSSIBLE COMPLICATIONS o Undue reliance on non-prescription caffeine-containing analgesics o Dependence/addiction to narcotic analgesics o GI bleed from NSAID use o Risk of addiction to analgesics o Risk of epilepsy is four times that of the general population EXPECTED COURSE/PROGNOSIS o Usually follows a chronic course when life stressors are not changed o Most cases are intermittent and should not interfere with work or normal life span
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
X-RAY CERVICAL VERTIBRAE A.P. & LAT. VIEW, CT SCAN HEAD, COMPLETE BLOOD COUNT, THYROID PROFILE
[TENSION HEADACHE]