Tension headache - CNS causes of headache

Tension headache

Definition

Recurrent headaches which are usually feel like a band or tight sensation around the head.

Aetiology/pathophysiology

The most common type of headache. The aetiology of tension headache is not known although possible factors include stress, concentrated visual effort, previous head injury and analgesia abuse. It appears that the mechanisms of tension headache are similar to migraine, although to a lesser degree.

Clinical features

Some patients have almost daily headaches, with the pain constant or waxing and waning. They complain of a band around the head, pressure behind the eyes and a dull or throbbing headache. The presence of a long history of such headaches is very suggestive of tension headache.

Investigations

CT brain is not usually indicated. In acute cases in older patients, an ESR should be sent to exclude temporal arteritis.

Management

Reassurance, avoiding any precipitating factors and treatment with analgesics such as paracetamol or NSAIDs. Combination drugs which include caffeine, codeine or ergotamine should be avoided, as they can cause rebound headaches and substance dependency. Chronic tension headaches may be relieved by the use of amitryptiline.