Materiały źródłowe

• #1 Tension-Type Headache: Symptoms, Types and Treatments

  https://americanmigrainefoundation.org/resource-library/tension-type-headache/

  Tension-type headache is one of the most common types of headache, estimated to affect 2 in 3 adults in the U.S. […] Like migraine, there are no diagnostic tests to confirm a tension-type headache. Doctors make a diagnosis by reviewing a patient’s personal and family medical history, evaluating their symptoms and conducting a physical examination. […] Symptoms similar to those of a tension-type headache can in some cases be attributed to more serious underlying causes or conditions, so doctors should consider this possibility when patients suspect they have tension-type headache. […] A tension-type headache is not accompanied by nausea or vomiting. […] It is, however, possible for a tension-type headache to trigger a migraine attack in people with a history of migraine. […] More frequent tension-type headaches may require daily preventive medications or complementary therapies to restore health and quality of life. […] It can often be treated with over-the-counter medications and a bit of rest. Still, to be on the safe side, a doctor should always diagnose headaches. […] A tension-type headache is not made worse by physical activity.

• #2 Tension-type headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2190284/

  Episodic tension-type headache is the most common cause of headache in the general population and is usually self managed. […] Chronic tension-type headache may be highly disabling and often prompts medical consultation. […] Diagnosis is clinical, based on widely accepted and validated criteria. […] The diagnosis is based on the history and examination. […] If a patient meets the criteria for tension-type headache and has a normal result on neurological examination, further diagnostic testing generally is not helpful. […] Manual palpation of pericranial muscles is a valuable but underused physical examination technique: pericranial muscle tenderness on palpation is the most common abnormal finding in tension-type headache, although its absence does not rule out tension-type headache.

• #3 2.3 Chronic tension-type headache – ICHD-3

  https://ichd-3.org/2-tension-type-headache/2-3-chronic-tension-type-headache/

  2.3 Chronic tension-type headache […] Diagnostic criteria: […] 1. Headache occurring on ≥15 days/month on average for >3 months (≥180 days/year), fulfilling criteria B-D […] 2. Lasting hours to days, or unremitting […] 3. At least two of the following four characteristics: […] – bilateral location […] – pressing or tightening (non-pulsating) quality […] – mild or moderate intensity […] – not aggravated by routine physical activity such as walking or climbing stairs […] 4. Both of the following: […] – no more than one of photophobia, phonophobia or mild nausea […] – neither moderate or severe nausea nor vomiting […] 5. Not better accounted for by another ICHD-3 diagnosis. […] Notes: […] 1. Both 2.3 Chronic tension-type headache and 1.3 Chronic migraine require headache on 15 or more days/month. For 2.3 Chronic tension-type headache, headache must, on at least 15 days, meet criteria B-D for 2.2 Frequent episodic tension-type headache; for 1.3 Chronic migraine headache must, on at least eight days, meet criteria B-D for 1.1 Migraine without aura. A patient can therefore fulfil all criteria for both these diagnoses, for example by having headache on 25 days/month meeting migraine criteria on eight days and tension-type headache criteria on 17 days. In these cases, only the diagnosis 1.3 Chronic migraine should be given.

• #4 Muscle Contraction Tension Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562274/

  TTH is often linked to stress, poor posture, and muscle tension, with a multifactorial etiology involving both peripheral and central mechanisms. […] Diagnosis is primarily clinical, based on characteristic symptoms such as bilateral, pressing, or tightening pain without associated nausea or vomiting and the absence of more severe neurological signs. […] TTH may be distinguished from other primary and secondary headaches using the International Headache Society (IHS) definition and diagnostic criteria. […] The IHS has proposed the diagnostic criteria for TTH in the 3rd edition of the International Classification of Headache Disorders (ICHD-3). The criteria are as follows: A. At least 10 episodes of headache fulfilling criteria B to D. B. Lasting from 30 minutes to as long as 7 days. C. At least 2 of the following 4 characteristics: Bilaterally located, Pressing or tightening (nonpulsating) quality, Mild or moderate in intensity, Not exacerbated by routine physical activity, such as walking or climbing stairs. D. Both of the following: No nausea or vomiting, No more than 1 of either photophobia or phonophobia. E. Not better explained by another ICHD-3 diagnosis. […] TTH is a clinical diagnosis based on the IHS diagnostic criteria. No laboratory testing or imaging studies are usually necessary for diagnosing this condition.

• #5 How to diagnose tension headaches | Medmastery

  https://www.medmastery.com/guides/headaches-clinical-guide/how-diagnose-tension-headaches?srsltid=AfmBOoqVTVi7p8oSGkwDjYl3njst-98LB6bXhzkmkvgCo4HF-DgBDxC2

  Tension headaches are the most common type of primary headache disorder seen in practice, and perhaps the most misunderstood. […] Tension headaches are often bilateral, and are described by patients as pressure-like, vice-like, cap-like or merely as a tightness. […] The intensity of tension headaches can vary, but it is rarely severe, and generally, they are not aggravated by activity. […] There are four key criteria that must be met for a diagnosis of tension headache: The headache typically lasts from 30 minutes to seven days. The headaches have at least two of the following four characteristics: They are bilateral, They have a pressing or tightening (non-pulsating) quality, They are of mild or moderate intensity, They are not aggravated by routine physical activity such as walking or climbing stairs. There must be no nausea or vomiting, and while photophobia or phonophobia may occur, it must not be both. These headaches are not better accounted for by another International Classification of Headache Disorders 3rd edition diagnosis or any other reasonable cause.

• #6 Tension headache • LITFL • Neurology library

  https://litfl.com/tension-headache/

  Tension headaches are the most common type of primary headache disorder seen in practice, and perhaps the most misunderstood. […] There are four key criteria that must be met for a diagnosis of tension headache: […] The headache typically lasts from 30 minutes to seven days. […] The headaches have at least two of the following four characteristics. They are: bilateral, have a pressing or tightening (non-pulsating) quality, mild or moderate intensity, not aggravated by routine physical activity such as walking or climbing stairs. […] There must be no nausea or vomiting, and while photophobia or phonophobia may occur, it must not be both. […] These headaches are not better accounted for by another International Classification of Headache Disorders 3rd edition diagnosis or any other reasonable cause.

• #7 Headache: What It Is, Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9639-headaches

  If you have headaches often or if theyre very severe, reach out to your healthcare provider. […] Its important to diagnose headaches correctly so your provider can prescribe specific therapy to help you feel better. Your provider will complete a physical examination, discuss your medical history and talk to you about your headache symptoms. This conversation is part of a headache evaluation. […] After evaluating the results of your headache history, physical examination and neurological examination, your physician should be able to determine what type of headache you have, whether or not a serious problem is present and whether additional tests are needed. […] Although scans and other imagining tests can be important when ruling out other diseases, they dont help in diagnosing migraines, cluster or tension-type headaches.

• #8 Diagnosing Headache | NYU Langone Health

  https://nyulangone.org/conditions/headache/diagnosis

  To determine the type of headache causing your pain, neurologists at NYU Langone ask about your headache history and symptoms, focusing on the frequency, intensity, duration, location, and any known triggers. […] Your doctor also conducts a comprehensive review of your medical history and family history of headache and performs a physical exam to obtain a complete picture of your health. […] Depending on your symptoms and the results of your medical and neurologic examinations, your physician may recommend further diagnostic testing. […] Your doctor may use one or more of the following tests to arrive at the most accurate diagnosis. […] A neurological examination may include an evaluation of your mental status, motor strength, vision, and reflex testing. […] Your doctor may order an MRI scan to view the inside of the head and neck.

• #9

  https://www.healio.com/clinical-guidance/headaches/diagnosis-presentation-and-diagnosis

  Obtaining a complete headache history is the most vital tool in the diagnosis and management of a patient with headache. Items that should be included in the headache history to simplify this process include: Type of headache, Onset, Frequency, Site, Duration, Severity and character, Prodromata (symptoms preceding the headache), Associated symptoms, Precipitating factors, Sleep pattern, Emotional factors, Family history, Medical, surgical, and/or obstetric history, Allergy, Previous medications and therapies, Current medications. […] Determining the age at onset of the headaches may provide a significant clue to the type of headache the patient is experiencing. Migraine headaches usually start in adolescence or the early 20s. Patients with cluster headaches will usually describe headache onset in their third, fourth, or fifth decade. Patients with tension-type headaches (TTHs) will note that the headaches started during their 30s or 40s. The clinician should rule out secondary causes (e.g., organic disease) in those patients whose headaches start after age 50.

• #10 Assessment, diagnosis, and management of headache –

  https://www.npwomenshealthcare.com/assessment-diagnosis-and-management-of-headache/

  Healthcare providers caring for women can use advanced clinical skills in assessment and accurate diagnosis of headaches. Accurate diagnosis is imperative in providing effective management and making appropriate referrals. The overall goal is to make the correct diagnosis, adequately treat the headaches, and minimize the frequency and severity of headaches in the future. […] A complete history is key in making the diagnosis. Although symptoms of various types of headache may overlap, a detailed history helps the HCP determine whether a secondary cause needs to be further investigated or if the symptoms fit with one of the primary headache types. […] Red flags in the history require that further evaluation be done for secondary causes. Sudden onset of a severe, intractable headache may suggest an intracranial disorder such as subarachnoid hemorrhage or meningitis.

• #11 Tension-type headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2190284/

  Episodic tension-type headache is the most common cause of headache in the general population and is usually self managed. […] Chronic tension-type headache may be highly disabling and often prompts medical consultation. […] Diagnosis is clinical, based on widely accepted and validated criteria. […] The diagnosis is based on the history and examination. […] If a patient meets the criteria for tension-type headache and has a normal result on neurological examination, further diagnostic testing generally is not helpful. […] Manual palpation of pericranial muscles is a valuable but underused physical examination technique: pericranial muscle tenderness on palpation is the most common abnormal finding in tension-type headache, although its absence does not rule out tension-type headache.

• #12 Tension-Type Headache – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/headache/tension-type-headache

  Tension-type headache causes mild generalized pain (usually viselike) without the incapacity, nausea, or photophobia associated with migraine. […] Diagnosis of tension-type headache is based on characteristic symptoms and a normal physical examination, which includes a neurologic examination. Potential triggers for chronic tension-type headache should be identified and treated. […] If headaches are severe in a patient thought to have tension-type headaches, the diagnosis should be reconsidered; severe tension-type headaches are often migraines. […] Reconsider the diagnosis of tension-type headache if headache is severe, particularly in a patient who has concomitant migraine or a history of prior migraine headaches.

• #13 Tension-Type Headaches | Diagnosis & Treatment for Physios

  https://www.physiotutors.com/conditions/tension-type-headaches/

  Tension-type headaches can vary from infrequent episodic, frequent episodic, to chronic. […] While the frequency and duration differ, patients in all three categories need to report at least 2 of the following four characteristics (ICD-H-III): The headache is bilateral, It has a pressing or tightening quality but NOT pulsating, The intensity is mild to moderate so a patient will usually still be able to complete ADLs as, The headache is not aggravated by routine physical activity such as walking or climbing stairs. […] Also, there is NO nausea or vomiting, No more than one of photophobia or phonophobia which is sensitivity to light and sounds respectively. […] Tools you can use to assess the impact of a headache on your patient are the HIT-6 questionnaire. […] Therefore asking them to complete a headache diary can help in the assessment and management of the headache and you should be aware that there can be overlap between multiple headache disorders.

• #14 Tension-type headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2190284/

  Episodic tension-type headache is the most common cause of headache in the general population and is usually self managed. […] Chronic tension-type headache may be highly disabling and often prompts medical consultation. […] Diagnosis is clinical, based on widely accepted and validated criteria. […] The diagnosis is based on the history and examination. […] If a patient meets the criteria for tension-type headache and has a normal result on neurological examination, further diagnostic testing generally is not helpful. […] Manual palpation of pericranial muscles is a valuable but underused physical examination technique: pericranial muscle tenderness on palpation is the most common abnormal finding in tension-type headache, although its absence does not rule out tension-type headache.

• #15 Tension headache differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Tension_headache_differential_diagnosis

  Differential diagnosis of tension-type headache includes; Migraine, Cluster headache, Secondary headaches such as Medication overuse, Sinus headache and Cervicogenic headache. […] Differential diagnosis of tension-type headache includes: Migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity etc. […] Diagnosis of meningitis, is based on clinical presentation in combination with CSF analysis. CSF analysis has major role for diagnosis and rule out other possibilities.

• #16 Tension-type headache | MedLink Neurology

  https://www.medlink.com/articles/tension-type-headache

  According to the ICHD-3, chronic tension-type headache must be separated from new daily persistent headache. […] The main differential diagnosis for episodic tension-type headache is episodic migraine. […] The phenotype of chronic tension-type headache can occur with or without medication overuse, and the combination should always be considered to optimize treatment. […] A thorough history and neurologic examination including fundoscopy is the main workup required to diagnose tension-type headache. […] Red flags in the history or abnormalities on examination should prompt further investigation. […] MRI should be done if any red flags are present, as any structural or metabolic cause of headache can present as phenotypic tension-type headache. […] First-line acute treatments for tension-type headache are aspirin or acetaminophen, whereas second-line are NSAIDs and caffeine combinations.

• #17 2. Tension-type headache (TTH) – ICHD-3

  https://ichd-3.org/2-tension-type-headache/

  In the case of chronic tension-type headache in association with medication overuse, a close temporal relation is often difficult to establish. Both diagnoses, 2.3 Chronic tension-type headache and 8.2 Medication-overuse headache, should therefore be given in all such cases. […] The diagnostic difficulty most often encountered among the primary headache disorders is in discriminating between 2. Tension-type headache and mild forms of 1.1 Migraine without aura. […] Stricter diagnostic criteria have been suggested for 2. Tension-type headache in the hope of excluding migraine that phenotypically resembles tension-type headache. […] However, the increase in specificity of the criteria reduces their sensitivity, resulting in larger proportions of patients whose headaches can be classified only as 2.4 Probable tension-type headache or 1.5 Probable migraine.

• #18 Tension-type headache – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/tension-type-headache/

  Tension-type headache is primarily a clinical diagnosis based on a history of typical features and normal neurological examination. Severe underlying conditions should be ruled out (see red flags for headache and Diagnostics in Headache). A headache diary can be helpful to establish the diagnosis and guide management. […] Diagnostic criteria for tension-type headaches include at least two of the following: dull, pressing, nonpulsating quality; mild to moderate intensity; bilateral; no increase in intensity with exertion. […] Tension-type headaches may be difficult to differentiate from mild forms of migraine without aura, and some patients may have both disorders.

• #19 Debate: differences and similarities between tension-type headache and migraine | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01614-0

  Tension-type headache (TTH) and migraine are two common primary headaches distinguished by clinical characteristics according to the 3rd edition of the International Classification of Headache Disorders. […] However, distinguishing between TTH and migraine in clinical practice, research, and epidemiological studies can be challenging, as there is a lack of specific diagnostic tests and biomarkers. […] The challenges associated with distinguishing TTH from migraine in clinical practice, clinical research, and epidemiological studies have been widely recognized. […] As there are currently no specific diagnostic tests and biomarkers available, the diagnosis of most primary headache disorders continues to rely solely on clinical assessment, making the diagnostic process complicated. […] This can result in clinicians mistakenly diagnosing a patient with migraine when they are actually experiencing TTH, and vice versa.

• #20 Tension-type Headache: Symptoms and Treatment | Doctor

  https://patient.info/doctor/tension-type-headache-pro

  TTH is probably overdiagnosed: often what is diagnosed as TTH is in fact migraine. Always consider migraine if the headache had migrainous components. […] As with many headache disorders, a good history (see box below) is essential to make the diagnosis. There are both physical and psychological aetiological factors. With the correct diagnosis, effective treatment and advice can be offered. […] Diagnosis of TTH is suggested by two of the following in at least ten previous headaches: Bilateral or generalised, and of mild-to-moderate intensity (interfering with but not preventing activities). Frontal-occipital. Non-pulsatile in quality (pressing or tightening). Not aggravated by routine physical activity. […] TTH is suggested by the following history: 10 or more previous headache episodes. Often present at, or soon after, getting up in the morning. Chronicity: a duration of more than five years is described by 75% of patients with the chronic variety. Duration ranging from 30 minutes to seven days.

• #21 Acute Headache in Adults: A Diagnostic Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/acute-headache-adults.html

  A detailed history and physical examination can distinguish between key features of a benign primary headache and concerning symptoms that warrant further evaluation for a secondary headache. […] Most headaches assessed in primary care are benign. It is important to diagnose a patient’s headache accurately and identify patients for whom an additional but less urgent evaluation is necessary. […] Patients with headache and red flags (acute thunderclap headache, fever with meningeal irritation on physical examination, papilledema with focal neurologic signs or impaired consciousness, concern for acute glaucoma) in their history or physical examination warrant further investigation for secondary causes of headache. […] Patients with stable primary headache disorders (i.e., no red flags and normal neurologic examination) do not need neuroimaging.

• #22 Headache – Wikipedia

  https://en.wikipedia.org/wiki/Headache

  Most headaches can be diagnosed by the clinical history alone. […] If the symptoms described by the person sound dangerous, further testing with neuroimaging or lumbar puncture may be necessary. […] The first step to diagnosing a headache is to determine if the headache is old or new. […] A „new headache” can be a headache that has started recently, or a chronic headache that has changed character. […] It can be challenging to differentiate between low-risk, benign headaches and high-risk, dangerous headaches since symptoms are often similar. […] Headaches that are possibly dangerous require further lab tests and imaging to diagnose. […] The American College for Emergency Physicians published criteria for low-risk headaches. […] A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes which may be life-threatening or cause long-term damage.

• #23 Assessment, diagnosis, and management of headache –

  https://www.npwomenshealthcare.com/assessment-diagnosis-and-management-of-headache/

  Physical examination of a patient presenting with a chief complaint of headache includes a general survey, vital signs, focused assessment of the head and neck, and a full neurologic exam. […] Red flags in the physical examination include, but are not limited to, fever, weight loss, altered mental status, weakness, papilledema, focal neurologic deficits, proximal artery tenderness, and meningismus. […] Because of overlapping symptomatology among the different headache types, the diagnosis of a particular headache type can be challenging. In addition, the HCP must discern between a primary headache, which, although painful, is usually not harmful, and a secondary headache such as subarachnoid hemorrhage or transient ischemic attack, which could lead to a stroke. […] Tension headaches can be episodic (usually associated with a stressful event) or chronic (usually associated with muscular contraction in the neck and scalp). Definitive diagnosis includes two of these traits: pressing or tightening pain; occipitofrontal location; bilateral pain, with mild to moderate intensity; and lack of effect of physical activity.

• #24 Headache – Wikipedia

  https://en.wikipedia.org/wiki/Headache

  In general, people complaining of their „first” or „worst” headache warrant imaging and further workup. […] The American Headache Society recommends using „SSNOOP”, a mnemonic to remember the red flags for identifying a secondary headache. […] New headaches are more likely to be dangerous secondary headaches. […] One recommended diagnostic approach is as follows. […] If any urgent red flags are present such as visual impairment, new seizures, new weakness, or new confusion, further workup with imaging and possibly a lumbar puncture should be done. […] If the headache is sudden onset (thunderclap headache), a computed tomography scan (CT scan) to look for a brain bleed (subarachnoid hemorrhage) should be done. […] If the CT scan does not show a bleed, a lumbar puncture should be done to look for blood in the cerebrospinal fluid (CSF), as the CT scan can be falsely negative and subarachnoid hemorrhages can be fatal.

• #25 Acute Headache in Adults: A Diagnostic Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/acute-headache-adults.html

  Patients with acute thunderclap headache should be sent to the emergency department and should receive computed tomography of the head within 12 hours of symptom onset. […] Lumbar puncture must follow a normal computed tomography scan to exclude subarachnoid hemorrhage. […] Patients with stable primary headache disorders do not typically need neuroimaging. […] A headache accompanied by an abnormal neurologic examination likely suggests an underlying etiology. […] Neuroimaging and an additional evaluation may be necessary to exclude life-threatening causes of headaches when red flags are present. […] For emergent evaluations of headache, non-contrast computed tomography (CT) of the head is sensitive enough to exclude a new intracranial hemorrhage or mass effect. […] Brain magnetic resonance imaging (MRI) with and without contrast is the preferred method for evaluating headaches with other concerning features.

• #26 Tension-type headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2190284/

  Episodic tension-type headache is the most common cause of headache in the general population and is usually self managed. […] Chronic tension-type headache may be highly disabling and often prompts medical consultation. […] Diagnosis is clinical, based on widely accepted and validated criteria. […] The diagnosis is based on the history and examination. […] If a patient meets the criteria for tension-type headache and has a normal result on neurological examination, further diagnostic testing generally is not helpful. […] Manual palpation of pericranial muscles is a valuable but underused physical examination technique: pericranial muscle tenderness on palpation is the most common abnormal finding in tension-type headache, although its absence does not rule out tension-type headache.

• #27 Muscle Contraction Tension Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562274/

  TTH is often linked to stress, poor posture, and muscle tension, with a multifactorial etiology involving both peripheral and central mechanisms. […] Diagnosis is primarily clinical, based on characteristic symptoms such as bilateral, pressing, or tightening pain without associated nausea or vomiting and the absence of more severe neurological signs. […] TTH may be distinguished from other primary and secondary headaches using the International Headache Society (IHS) definition and diagnostic criteria. […] The IHS has proposed the diagnostic criteria for TTH in the 3rd edition of the International Classification of Headache Disorders (ICHD-3). The criteria are as follows: A. At least 10 episodes of headache fulfilling criteria B to D. B. Lasting from 30 minutes to as long as 7 days. C. At least 2 of the following 4 characteristics: Bilaterally located, Pressing or tightening (nonpulsating) quality, Mild or moderate in intensity, Not exacerbated by routine physical activity, such as walking or climbing stairs. D. Both of the following: No nausea or vomiting, No more than 1 of either photophobia or phonophobia. E. Not better explained by another ICHD-3 diagnosis. […] TTH is a clinical diagnosis based on the IHS diagnostic criteria. No laboratory testing or imaging studies are usually necessary for diagnosing this condition.

• #28 Tension Headache Workup: Approach Considerations

  https://emedicine.medscape.com/article/792384-workup

  Laboratory work should be unremarkable in cases of tension-type headache. Specific tests should be obtained if the history or physical examination suggests another diagnostic possibility. […] Head CT scan or MRI is necessary only when the headache pattern has changed recently, the headache cannot be clearly defined by the clinician as a common primary headache disorder (that is not a cluster, migraine, or tension-type of headache), or neurologic examination reveals abnormal findings. Such history or physical examination evidence would suggest an alternate cause of headache. Caution should be used in patients with aura in headache that is sensory or motor, or if the aura has changed in character and is not described as typical of their migraine aura. These patients may warrant neuroimaging.

• #29 Headaches | Migraines – Causes, Diagnostic Tests and Treatment

  https://www.radiologyinfo.org/en/info/headache

  Your doctor may order head MRI, head CT or lumbar puncture to help diagnose and evaluate your condition. […] To diagnose the cause of headaches and to rule out underlying medical conditions, physicians obtain a patient history and conduct a careful neurological examination. Diagnostic testing may include the following imaging tests: […] CT imaging of the head: Computed tomography (CT) scanning combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. […] MRI of the head: Magnetic resonance imaging (MRI) uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. […] Lumbar puncture (also called a spinal tap): This diagnostic test involves removing and analyzing a small amount of cerebrospinal fluidthe fluid that surrounds the brain and spinal cord from the lumbar (or lower) region of the spinal column. […] CT Angiography: If your doctor suspects you may have an aneurysm, you may undergo CT Angiography.

• #30

  https://www.healio.com/clinical-guidance/headaches/diagnosis-presentation-and-diagnosis

  Diagnostic testing may be required to rule out secondary causes of headache and to establish a baseline of some parameters. […] If the physician is not confident of the diagnosis, or if certain aspects of the history suggest possible organic causes of the headache, neuroimaging should be considered. […] The Standards of Care of the National Headache Foundation have established guidelines to determine whether neuroimaging is indicated. […] This invasive procedure should only be undertaken if the symptoms warrant. A patient presenting with fever and neck stiffness should undergo a lumbar puncture to rule out intracranial infection. […] The EEG is not used extensively because of the availability and efficiency of other tests. This test is indicated in patients presenting with headache accompanied by seizure. Its results are inconclusive in most patients with chronic headache. […] Obtaining baseline values for blood chemistries, complete blood count (CBC), and urinalysis will assist the physician in continuing therapy in patients with headache.

• #31 Acute Headache in Adults: A Diagnostic Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/acute-headache-adults.html

  Patients with acute thunderclap headache should be sent to the emergency department and should receive computed tomography of the head within 12 hours of symptom onset. […] Lumbar puncture must follow a normal computed tomography scan to exclude subarachnoid hemorrhage. […] Patients with stable primary headache disorders do not typically need neuroimaging. […] A headache accompanied by an abnormal neurologic examination likely suggests an underlying etiology. […] Neuroimaging and an additional evaluation may be necessary to exclude life-threatening causes of headaches when red flags are present. […] For emergent evaluations of headache, non-contrast computed tomography (CT) of the head is sensitive enough to exclude a new intracranial hemorrhage or mass effect. […] Brain magnetic resonance imaging (MRI) with and without contrast is the preferred method for evaluating headaches with other concerning features.

• #32 Acute Headache in Adults: A Diagnostic Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/acute-headache-adults.html

  A detailed history and physical examination can distinguish between key features of a benign primary headache and concerning symptoms that warrant further evaluation for a secondary headache. […] Most headaches assessed in primary care are benign. It is important to diagnose a patient’s headache accurately and identify patients for whom an additional but less urgent evaluation is necessary. […] Patients with headache and red flags (acute thunderclap headache, fever with meningeal irritation on physical examination, papilledema with focal neurologic signs or impaired consciousness, concern for acute glaucoma) in their history or physical examination warrant further investigation for secondary causes of headache. […] Patients with stable primary headache disorders (i.e., no red flags and normal neurologic examination) do not need neuroimaging.

• #33 Headache – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/headache/

  Headache is a symptom commonly encountered in everyday clinical practice, and, according to the WHO, one of the ten most common causes of functional disability. Identifying the cause of headaches is often difficult and requires a detailed clinical history as well as a thorough physical examination. Additional diagnostics, e.g., imaging, are only indicated if headaches persist despite treatment or if specific clinical features are present that are signs of an underlying disease. […] The diagnostic modality should be determined by the patient history and clinical presentation. Primary headache is a clinical diagnosis and typically does not require laboratory or imaging evaluation. […] In patients who are unstable or have signs of increased ICP, diagnostics should not delay stabilization (e.g., ABCDE approach) and neuroprotective measures.

• #34 Tension-type headache – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/tension-type-headache/

  Tension-type headache is primarily a clinical diagnosis based on a history of typical features and normal neurological examination. Severe underlying conditions should be ruled out (see red flags for headache and Diagnostics in Headache). A headache diary can be helpful to establish the diagnosis and guide management. […] Diagnostic criteria for tension-type headaches include at least two of the following: dull, pressing, nonpulsating quality; mild to moderate intensity; bilateral; no increase in intensity with exertion. […] Tension-type headaches may be difficult to differentiate from mild forms of migraine without aura, and some patients may have both disorders.

• #35 Tension-Type Headaches | Diagnosis & Treatment for Physios

  https://www.physiotutors.com/conditions/tension-type-headaches/

  Tension-type headaches can vary from infrequent episodic, frequent episodic, to chronic. […] While the frequency and duration differ, patients in all three categories need to report at least 2 of the following four characteristics (ICD-H-III): The headache is bilateral, It has a pressing or tightening quality but NOT pulsating, The intensity is mild to moderate so a patient will usually still be able to complete ADLs as, The headache is not aggravated by routine physical activity such as walking or climbing stairs. […] Also, there is NO nausea or vomiting, No more than one of photophobia or phonophobia which is sensitivity to light and sounds respectively. […] Tools you can use to assess the impact of a headache on your patient are the HIT-6 questionnaire. […] Therefore asking them to complete a headache diary can help in the assessment and management of the headache and you should be aware that there can be overlap between multiple headache disorders.

• #36 Tension Headaches | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/tension-headaches

  Tension-type headaches usually are diagnosed based on symptoms. Your doctor will ask about the severity, frequency and duration of your headaches as well as other symptoms that occur and medications you are taking. Keeping a headache journal is a good way to track the location and severity of pain, duration of pain, medications taken and possible headache triggers. […] If your doctor suspects a tumor or aneurysm, you may undergo one or more of the following tests: […] A CT scan uses a thin X-ray beam that rotates around the area being examined. A computer processes data to create a 3-D, cross-sectional image. […] An MRI uses magnetism, radio waves and computer technology, rather than X-rays, to produce images of your brain. Under the right circumstances, MRI and other imaging procedures allow doctors to see how larger structures in the brain are involved during migraine and headache.

• #37 Tension-Type Headaches | Diagnosis & Treatment for Physios

  https://www.physiotutors.com/conditions/tension-type-headaches/

  Tension-type headaches can vary from infrequent episodic, frequent episodic, to chronic. […] While the frequency and duration differ, patients in all three categories need to report at least 2 of the following four characteristics (ICD-H-III): The headache is bilateral, It has a pressing or tightening quality but NOT pulsating, The intensity is mild to moderate so a patient will usually still be able to complete ADLs as, The headache is not aggravated by routine physical activity such as walking or climbing stairs. […] Also, there is NO nausea or vomiting, No more than one of photophobia or phonophobia which is sensitivity to light and sounds respectively. […] Tools you can use to assess the impact of a headache on your patient are the HIT-6 questionnaire. […] Therefore asking them to complete a headache diary can help in the assessment and management of the headache and you should be aware that there can be overlap between multiple headache disorders.

• #38 2.3 Chronic tension-type headache – ICHD-3

  https://ichd-3.org/2-tension-type-headache/2-3-chronic-tension-type-headache/

  2. 2.3 Chronic tension-type headache evolves over time from 2.2 Frequent episodic tension-type headache; when these criteria A-E are fulfilled by headache that, unambiguously, is daily and unremitting from less than 24 hours after its first onset, code as 4.10 New daily persistent headache. When the manner of onset is not remembered or is otherwise uncertain, code as 2.3 Chronic tension-type headache. […] 3. In many uncertain cases there is overuse of medication. When this fulfils criterion B for any of the subtypes of 8.2 Medication-overuse headache and the criteria for 2.3 Chronic tension-type headache are also fulfilled, the rule is to code for both 2.3 Chronic tension-type headache and 8.2 Medication-overuse headache. After drug withdrawal, the diagnosis should be re-evaluated: not uncommonly the criteria for 2.3 Chronic tension-type headache will no longer be fulfilled, with reversion to one or other episodic type. When the disorder remains chronic after withdrawal, the diagnosis of 8.2 Medication-overuse headache may be rescinded.

• #39 Tension headache – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tension-headache/diagnosis-treatment/drc-20353982

  Your health care professional monitors your treatment to see how the preventive medicine is working. In the meantime, overusing pain relievers may interfere with the effects of the preventive medicines. […] For tension-type headaches, some basic questions to ask your health care professional include: […] Your health care professional may ask you several questions, such as:

• #40 2.3 Chronic tension-type headache – ICHD-3

  https://ichd-3.org/2-tension-type-headache/2-3-chronic-tension-type-headache/

  2. 2.3 Chronic tension-type headache evolves over time from 2.2 Frequent episodic tension-type headache; when these criteria A-E are fulfilled by headache that, unambiguously, is daily and unremitting from less than 24 hours after its first onset, code as 4.10 New daily persistent headache. When the manner of onset is not remembered or is otherwise uncertain, code as 2.3 Chronic tension-type headache. […] 3. In many uncertain cases there is overuse of medication. When this fulfils criterion B for any of the subtypes of 8.2 Medication-overuse headache and the criteria for 2.3 Chronic tension-type headache are also fulfilled, the rule is to code for both 2.3 Chronic tension-type headache and 8.2 Medication-overuse headache. After drug withdrawal, the diagnosis should be re-evaluated: not uncommonly the criteria for 2.3 Chronic tension-type headache will no longer be fulfilled, with reversion to one or other episodic type. When the disorder remains chronic after withdrawal, the diagnosis of 8.2 Medication-overuse headache may be rescinded.

• #41 Tension-type headache | MedLink Neurology

  https://www.medlink.com/articles/tension-type-headache

  According to the ICHD-3, chronic tension-type headache must be separated from new daily persistent headache. […] The main differential diagnosis for episodic tension-type headache is episodic migraine. […] The phenotype of chronic tension-type headache can occur with or without medication overuse, and the combination should always be considered to optimize treatment. […] A thorough history and neurologic examination including fundoscopy is the main workup required to diagnose tension-type headache. […] Red flags in the history or abnormalities on examination should prompt further investigation. […] MRI should be done if any red flags are present, as any structural or metabolic cause of headache can present as phenotypic tension-type headache. […] First-line acute treatments for tension-type headache are aspirin or acetaminophen, whereas second-line are NSAIDs and caffeine combinations.

• #42 Tension-type headache in the Emergency Department Diagnosis and misdiagnosis: The TEDDi study | Scientific Reports

  https://www.nature.com/articles/s41598-020-59171-4

  Headache is a common reason to visit the emergency department (ED). Tension-type headache (TTH) is the commonest headache. The diagnosis of TTH implies a mild condition, with no need for special tests. We evaluated the use of the International Classification of Headache Disorders (ICHD) criteria for TTH in the ED. […] Only five patients fulfilled TTH criteria. […] In our sample, TTH was overdiagnosed. Only a minority of patients fulfilled the ICHD criteria. Inconsistencies in prior medical history or anamnesis were frequent. […] The first objective was to analyse the percentage of patients who fulfilled the ICHD6 criteria for tension-type headache and the percentage of patients presenting each of the different criteria. The second objective was to analyse the presence of data in the discharge reports that contradicted TTH diagnosis, such as relevant prior medical data, atypical symptoms or abnormal findings in the examination. The third objective was to analyse whether patients could be re-classified as having other headache disorders by using the ICHD-3 criteria.

• #43 Debate: differences and similarities between tension-type headache and migraine | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01614-0

  Tension-type headache (TTH) and migraine are two common primary headaches distinguished by clinical characteristics according to the 3rd edition of the International Classification of Headache Disorders. […] However, distinguishing between TTH and migraine in clinical practice, research, and epidemiological studies can be challenging, as there is a lack of specific diagnostic tests and biomarkers. […] The challenges associated with distinguishing TTH from migraine in clinical practice, clinical research, and epidemiological studies have been widely recognized. […] As there are currently no specific diagnostic tests and biomarkers available, the diagnosis of most primary headache disorders continues to rely solely on clinical assessment, making the diagnostic process complicated. […] This can result in clinicians mistakenly diagnosing a patient with migraine when they are actually experiencing TTH, and vice versa.

• #44 Tension-type headache in the Emergency Department Diagnosis and misdiagnosis: The TEDDi study | Scientific Reports

  https://www.nature.com/articles/s41598-020-59171-4

  Only five patients fulfilled all ICHD criteria for TTH (2.4% of the included patients). […] There was at least one discrepancy in regard to anamnesis in 184 patients (87.2%). […] After reviewing all the discharge reports, only 21 patients (9.9% of the included sample, 0.98% of the total sample) fulfilled the ICHD-3 criteria for tension-type headache (five) or probable tension-type headache (16). […] In our sample, TTH was overdiagnosed in an emergency department, as only 2.4% of the patients fulfilled all ICHD criteria for TTH. Inconsistencies in prior medical history or anamnesis were present in the discharge reports in one-fifth and four-fifths of patients, respectively. Our analysis of medical records allowed us to reclassify these patients as having other primary or secondary headaches. Efforts to improve knowledge on headache disorders and ICHD are needed among ED physicians.

• #45 Debate: differences and similarities between tension-type headache and migraine | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01614-0

  Moreover, the coexistence of TTH and migraine can add further complexity to the diagnosis. […] The Spectrum Study found that 32% of patients who were initially diagnosed with TTH were later diagnosed with migraine or migrainous headache based on a neurologists evaluation of headache diaries and medical records kept for up to 6 months after the initial diagnosis. […] The current ICHD-3 diagnostic criteria for chronic migraine permit patients to have TTH-like headache.

• #46 Tension-type headache in the Emergency Department Diagnosis and misdiagnosis: The TEDDi study | Scientific Reports

  https://www.nature.com/articles/s41598-020-59171-4

  Only five patients fulfilled all ICHD criteria for TTH (2.4% of the included patients). […] There was at least one discrepancy in regard to anamnesis in 184 patients (87.2%). […] After reviewing all the discharge reports, only 21 patients (9.9% of the included sample, 0.98% of the total sample) fulfilled the ICHD-3 criteria for tension-type headache (five) or probable tension-type headache (16). […] In our sample, TTH was overdiagnosed in an emergency department, as only 2.4% of the patients fulfilled all ICHD criteria for TTH. Inconsistencies in prior medical history or anamnesis were present in the discharge reports in one-fifth and four-fifths of patients, respectively. Our analysis of medical records allowed us to reclassify these patients as having other primary or secondary headaches. Efforts to improve knowledge on headache disorders and ICHD are needed among ED physicians.

• #47 Tension Headache: Symptoms, Causes, Diagnosis, Treatment, Coping

  https://www.verywellmind.com/what-is-a-tension-headache-5224450

  Tension headaches are difficult to diagnose because there is an overlap of many symptoms with migraines, but a tension headache is generally diagnosed by the absence of migraine features, such as an aura or nausea. […] Two of the following features must be present for a tension headache diagnosis: A pressing or tightening of the head, Presence on both sides of the forehead, temples, or back of the head, Mild to moderate in severity, Not worsened by physical activity. […] There is a high rate of overlap between people with mood disorders and people who deal with tension headaches. In one study, 84% of the participants with tension headaches also had a psychiatric diagnosis, such as anxiety or depression. There is a theory that some tension headaches may be the physical manifestations of psychological distress.

• #48

  https://www.healio.com/clinical-guidance/headaches/diagnosis-presentation-and-diagnosis

  The frequency of headache attacks not only provides a clue to the diagnosis but also impacts the choice of treatment. Migraine typically occurs with a mean frequency of 1.5 attacks per month. Chronic TTHs are characterized by their daily occurrence. […] The TTH is notably bilateral and the pain may be described as a tight band around the head (hatband). Patients may also note pain radiating to the neck and shoulder. […] Tension-type headaches are continuous with occasional variations in severity. […] Chronic TTHs are persistent, dull, aching, or viselike. […] Patients suffering from chronic TTH often provide the treating physician with long lists of somatic, emotional, and psychic symptoms. […] A thorough physical and neurologic examination is essential to rule out organic pathology for headache as well as to determine which diagnostic tests are required.

• #49 Headache Diagnosis and Treatment | Brain Institute | OHSU

  https://www.ohsu.edu/brain-institute/headache-diagnosis-and-treatment

  You and your headache specialist will talk about your questionnaire and headache diary. You may be asked follow-up questions, such as: […] You may have tests, such as: […] Neurological exam: The doctor tests your reflexes and coordination to see if anything is wrong with your nervous system. […] Eye exam: The doctor inspects your optic nerves and pupil reflexes. […] Depression screening: People who get migraines are about four times more likely to have depression and anxiety. Its a two-way street, with depression and anxiety also leading to migraines. […] Imaging test: You may have an MRI or CT scan to look for or rule out an infection, tumor or other problem that could be causing your headaches. […] Ocular ultrasound: We use sound waves from a device outside your body to measure the coverings of your eye nerves (ocular nerve sheaths). Swelling indicates higher-than-normal pressure inside your head and possibly another condition causing your headache.

• #50 Tension-Type Headaches | Diagnosis & Treatment for Physios

  https://www.physiotutors.com/conditions/tension-type-headaches/

  Forward head posture (FHP) refers to the anterior positioning of the head relative to the torso in a reproducible upright posture. […] Measuring the horizontal gap between the tragus and the C7 spinous process has been reported to be the most reliable method compared to the horizontal gap between the tragus and acromion process and the craniovertebral angle between the tragus and the C7 spinous process. […] When looking at norm values the literature is rather scarce and usually, the craniovertebral angle is described as the sole measurement. […] In their randomized controlled trial, Harman et al. (2005) defined a forward head posture as soon as the distance between the tragus to the posterior angle of the acromion was greater than 5cm. […] Fernndez-de-las-Peas (et al. 2006) found a craniovertebral angle of 45.3 in patients with chronic TTH compared to an angle of 54.1 in healthy controls.

• #51 Tension-Type Headaches | Diagnosis & Treatment for Physios

  https://www.physiotutors.com/conditions/tension-type-headaches/

  In comparison with healthy controls, the average patient with tension-type headaches differs on provocation, cervical range of motion, neck muscle endurance and forward head position. […] The goal of provocation tests is to recreate the patients familiar pain. […] This way, you are able to confirm the location of nociception in the cervical structures, possibly leading to referred pain to the head. […] Upper cervical range of motion in the direction of rotation can be reliably and accurately assessed with the Flexion-Rotation Test. […] This test if positive can give you an indication of limited rotation on segments C1/C2. […] In turn, hypomobility on C0/C1 or C2/C3 can lead to this limitation in rotation on C1/C2. […] So in case of a positive test, we still need to perform intervertebral motion assessment of all upper cervical segments in order to find the dysfunctional segment.

• #52 Tension-type headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2190284/

  The history of headache features is most important in making a diagnosis; with the exception of pericranial muscle tenderness to manual palpation, physical and neurological examinations should yield normal results in patients with tension-type headache or any abnormalities should be explained by other conditions. […] If worrisome examination or historical features are present, secondary headache should be excluded with appropriate testing. […] Patients who regularly use acute medication for headache more than two to three days a week or whose headaches respond poorly to treatment should be referred to a specialist.

• #53 Tension headache Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/tension-headache.html

  There is no specific test to confirm the diagnosis of a tension-type headache. The diagnosis is determined by your description of the headache, other medical history and a normal physical examination. […] A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the head may be ordered. These imaging tests may be used to investigate headache pain that is associated with unexpected or unusual symptoms.

• #54 Tension Headache: Symptoms, Relief, and Treatment Options

  https://headacheaustralia.org.au/tension-headache/

  Tension headache is the most common cause of headache in the general population. However, chronic tension headache can be disabling, and requires medical consultation. It is important to diagnose headache disorders accurately to reduce stigma and help people get the right treatment. If your headache begins to interfere with your day-to-day life, please consult your doctor. Chronic tension headache is much less common, affecting about 3% of the general population. It evolves from episodic tension headache and is diagnosed when someone has headache on 15 or more days per month. You should make an appointment with your doctor if it begins to disrupt your daily life, or if you need to take painkillers more than twice a week. If you have already been diagnosed with frequent or chronic tension headache, you should also see a doctor if your attacks change or worsen in any way.

• #55 Headaches – Types, Causes, Symptoms, Diagnosis, Treatment

  https://www.webmd.com/migraines-headaches/migraines-headaches-basics

  Tension headaches are the most common type of headache among adults and teens. They cause mild to moderate pain and come and go over time. They usually have no other symptoms. […] Once you get your headaches diagnosed correctly, you can start the right treatment plan for your symptoms. […] The first step is to talk to your doctor about your headaches. Theyll give you a physical exam and ask about your symptoms and how often they happen. Its important to be as detailed as possible with these descriptions. […] Most people dont need special diagnostic tests. But sometimes, doctors suggest a CT scan or MRI to look for problems inside your brain that might cause your headaches. […] If your headache symptoms get worse or happen more often despite treatment, ask your doctor to refer you to a headache specialist.

• #56 Testing for Headache: Getting a Headache Diagnosis

  https://www.health.com/headache-diagnosis-7095039

  A healthcare provider will determine the type of headache you have based on various factors, including symptoms, severity, duration, and location of your pain. […] It’s a good idea to visit a healthcare provider if you begin to experience severe pain or headache symptoms that interrupt your daily life. […] They will also perform a physical exam and order any additional lab, blood, or imaging tests for headaches if necessary. […] Getting a diagnosis for headaches is important because it can help you and your provider figure out how to move forward with treatment and find ways to reduce your symptoms.

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