Tension-type Headache

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍tension type headacheheadache

Onset was ‍gradualsudden, and occurred ‍whileafter ‍

Location is ‍generalized, on the ‍rightleft

Rated at ‍012345678910 / 10 ‍

Described as ‍pressure-likedull ache

Pattern ‍persistentintermittent, worse during the ‍day

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective

Overuse of analgesics (> 10-15 days/month)



Associated symptoms: *Try using right-click for negatives*

‍neck pain

‍muscle tension

‍sensitivity to light

‍sensitivity to noise

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍visual disturbance

‍numbness or tingling

‍weakness

‍dizziness

‍loss of conscisousness

‍difficulty focusing

‍irritability

‍insomnia

‍fatigue

‍anxiety

‍depression



Contributing factors:

‍poor posture

‍prolonged computer use

‍lack of sleep

‍stress

no history of: ‍migraine, ‍chronic tension headache, ‍anxiety, ‍depression, ‍neck injury





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumatic, scalp ‍normalrashlesion

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Cervical spine: ‍tenderness on ‍, range of motion ‍fulllimited

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Tension-type headache ‍likelysuspectedpossible

DDx: tension-type headache, migraine, cluster headache, medication overuse headache, temporomandibular joint disorder, cervical spondylosis, sinusitis, giant cell arteritis, brain tumor, subarachnoid hemorrhage, meningitis, hypertension, anemia, sleep disorders, stress-related disorders, depression, anxiety, fibromyalgia





PLAN:

Investigations:

- CT scan of the head

- MRI of the head

- Blood work: ‍CBC, ‍TSH, ‍CRP, ‍ESR

Treatments:

- ‍Analgesics

- ‍Muscle relaxants

- ‍Prophylaxis medications

- Regular exercise

- Stress management techniques

- Sleep hygiene

- Avoidance of triggers (e.g. caffeine, alcohol, stress)

Further care:

- Referral to neurologist

- Referral to psychologist

- Follow-up in ‍ ‍weeksmonths

- Return if headaches worsen, if new symptoms develop such as vision changes or weakness, or if symptoms do not improve with treatment