Tension headache is the most common type of headache, a mild to moderate band-like pressure on both sides of the head. It is not made worse by routine activity and usually has no nausea, which helps tell it apart from migraine.
Key symptoms
- Pressing or tightening pain on both sides of the head
- Mild to moderate intensity
- No worsening with routine activity
- Neck or shoulder tightness
- Linked to stress, poor sleep or skipped meals
What you find on exam
- Normal neurological exam
- Tender scalp, neck and shoulder muscles
- Blood pressure check
- Fundoscopy to rule out papilledema
Tests
- Clinical diagnosis; no imaging needed with a normal exam
- Headache diary to track triggers and medicine use
- Imaging only if red flags
Treatment basics
- Ibuprofen, naproxen or acetaminophen for episodes
- Limit pain medicines to avoid medication-overuse headache
- Amitriptyline for frequent or chronic headache
- Stress management, sleep, exercise and physical therapy
Red flags
- Sudden, worst-ever headache
- Headache with fever, stiff neck or focal deficit
- New headache after age 50 or a change in pattern
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.