Tension headache

Background

Definition

1. Headache lasting from 30 min to 7 d
2. Headache has at least two of the following characteristics:
   • 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:
   • No nausea or vomiting (anorexia may occur)
   • 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
• 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

• Temporal arteritis
• Idiopathic intracranial hypertension (aka Pseudotumor Cerebri)
• Acute Glaucoma
• Acute sinusitis
• Cavernous sinus thrombosis or cerebral sinus thrombosis

Others

• 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
• Drug induced aseptic meningitis
• Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
• Noninfectious
  • Sarcoidosis
  • Vasculitis
  • Connective tissues disease

Management

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

Disposition

• Outpatient

See Also

• Headache

References

Authors

Ross Donaldson