Tension-Type Headache

Escalate beyond a primary-headache assessment when the history or examination identifies systemic symptoms or illness, fever, HIV or other immunocompromise, focal neurologic signs, sudden or thunderclap onset, onset at older age, or a substantive change in the established headache pattern. These SNOOP features warrant targeted urgent evaluation and usually neuroimaging rather than empiric treatment as uncomplicated tension-type headache. ajnrajnrHeadache and Neuroimaging: Why We Continue to Do It

Treat papilledema, rash or neck stiffness, cough- or exertion-triggered headache, pregnancy or postpartum headache, and a patient's worst headache as red flags. Select imaging and additional emergency workup according to the suspected process; the actionable point is that these features should interrupt a routine primary-headache pathway. ajnrajnrHeadache and Neuroimaging: Why We Continue to Do It

In the absence of red flags and with a stable compatible clinical pattern, make a positive diagnosis and explain the diagnosis and management plan; routine investigation solely to exclude alternative pathology is not required. nice org uk+1nice org ukHeadaches in over 12s: diagnosis and managementnice org ukHeadaches in over 12s: diagnosis and management - NICE

Document headache days per month and duration of the current frequency pattern. Tension-type headache is episodic at fewer than 15 headache days per month and chronic at 15 or more days per month for more than 3 months. This threshold identifies patients in whom recurrent acute treatment, disability assessment, and preventive options require explicit review. nice org uknice org ukHeadaches in over 12s: diagnosis and management

At every headache visit, count days of use—not simply tablets—for acetaminophen, NSAIDs, aspirin-containing products, combination analgesics, opioids, triptans, and ergot derivatives. Medication-overuse headache is defined by regular use for more than 3 months on at least 15 days per month for simple analgesics, including paracetamol or NSAIDs, or at least 10 days per month for triptans, ergotamines, opioids, or combination analgesics. Wolters KluwerWolters KluwerSmoking and medication-overuse headache : Cephalalgia

A patient with escalating headache days and threshold-level acute medication use should be managed as possible medication-overuse headache superimposed on a primary headache disorder, rather than by simply increasing rescue medication. Provide explicit counseling about medication-overuse risk whenever acute treatment is used. nice org uk+1nice org ukHeadaches in over 12s: diagnosis and managementnice org ukHeadaches in over 12s: diagnosis and management - NICE

For short-term treatment of tension-type headache, use ibuprofen 400 mg or acetaminophen 1000 mg as supported options. Choose ibuprofen only after considering NSAID-related risk, and choose acetaminophen with attention to the patient's total exposure from all products. acpjournalsacpjournals2023 U.S. Department of Veterans Affairs and ...

Aspirin, paracetamol/acetaminophen, or an NSAID may be considered for acute tension-type headache, with selection based on patient preference, comorbidities, and risk of adverse events. Do not offer aspirin-containing preparations to patients younger than 16 years because of the association with Reye syndrome. nice org uk+2nice org ukNATIONAL INSTITUTE FOR HEALTH AND CLINICAL ...nice org ukHeadaches in over 12s: diagnosis and managementnice org ukHeadaches in over 12s: diagnosis and management - NICE

Do not prescribe opioids for acute tension-type headache. Opioids also meet the lower medication-overuse threshold of at least 10 treatment days per month when used regularly for more than 3 months. Wolters Kluwer+2Wolters KluwerSmoking and medication-overuse headache : Cephalalgianice org ukNATIONAL INSTITUTE FOR HEALTH AND CLINICAL ...nice org ukHeadaches in over 12s: diagnosis and management

For chronic tension-type headache, consider a course of up to 10 acupuncture sessions delivered over 5 to 8 weeks as preventive treatment. This option is specifically recommended for the chronic frequency category, not merely for occasional episodic attacks. nice org uk+1nice org ukHeadaches in over 12s: diagnosis and managementnice org ukHeadaches in over 12s: diagnosis and management - NICE

If chronic headache coexists with regular acute-medication use at medication-overuse thresholds, address the overuse directly. Continued use of simple analgesics on at least 15 days per month, or combination analgesics, opioids, triptans, or ergotamines on at least 10 days per month, sustains a medication-overuse diagnostic pattern after more than 3 months of exposure. Wolters KluwerWolters KluwerSmoking and medication-overuse headache : Cephalalgia

Use a headache diary to capture headache days, acute-medication days by class, and change in headache phenotype. A rising frequency, a new neurologic symptom, or development of secondary-headache red flags should trigger diagnostic reassessment rather than automatic escalation of preventive care. ajnr+1ajnrHeadache and Neuroimaging: Why We Continue to Do Itnice org ukHeadaches in over 12s: diagnosis and management