Interactive Headache Flowchart

'Tension-type'  headaches may not be related to tension at all.

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They are often present every day and can be described as being like a tight band around the head.

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'Tension-type' headaches can be associated with tension and tenderness in the muscles of the neck and shoulders.

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GOLDEN RULE - a new persistent daily headache i.e. a headache lasting more than 2 weeks in a patient who has never had anything similar in the past (even if they are prone to migraines) should be investigated as a High pressure headache

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People often try to treat them with analgesics - paracetamol, co-codamol, tramadol, ibuprofen, diclofenac, naproxen - in the very short term this is fine; however if people take any analgesic regularly for any length of time they are at risk of medication induced headache. The official definition of medication induced headache is use of analgesics for more than 15 days per month for more than three months. Often patients will say 'I only take pain-killers when I need them' - ask how quickly they go through a packet of paracetamol.

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Be aware that people can 'tension-type' headache and migraine. Ask if they get days or hours where the headache is so bad that they can't do anything and want to go and lie down somewhere - if the do then they may have superimposed migraine.

 

Treatment of  tension-type headache should be:

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1. Physiotherapy then

2. Tricyclic antidepressants then

3. Selective serotonin reuptake inhibitors or serotonin and noradrenaline reuptake inhibitors (SSRI and SNRI) then

4. Referral for scalp injections

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Not co-codamol!