Exam Cram

• Tension headache is a physiologic headache from environmental stress

• Presentation: frontal headache, band, episodic; triggered by poor sleep, dehydration, alcohol, anxiety

• Diagnosis: clinical

• Management: hydration, rest, sparing paracetamol & NSAIDs

Outline

Background

• • Commonest cause of headache

  • Physiologic response to normal stressors: anxiety, dehydration and lack of sleep

  • Complications: chronic headaches, poor mental wellbeing

Assessment

History

• Headache: 

  • Mild-moderate

  • Frontal, tightening of band

  • Bilateral > unilateral

Examination

• Normal examination

Investigations

• Normal investigations, nil required for tension headache

Diagnosis

Diagnostic criteria: clinical

Differentials: migraine, medication overuse headache, GCA, cluster headache

Management

Acute

1. Lifestyle

   • Sleep hygiene

   • Oral hydration

   • Regular exercise, fresh air, stress reduction

2. Medication: 

   • As required paracetamol & ibuprofen (note risks of medication overuse headache)

Deeper Dive

Prognosis

Self resolving with lifestyle changes

Chronic Headaches

Diagnosis: ongoing for > 6 weeks & causing significant harm/ disability 

Management

1. Neurology Opinion

2. Propranolol

3. Topiramate

4. Amitriptyline

Pathophysiology

Some believe tension headaches to be part of the same pathophysiology as migraines. For myself, tension headaches are physiologic and anyone can experience on however migraines have a genetic component and only effect a proportion of the population. 

Written in 2025