a) Tension Type Headache |
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There are two types:- Episodic TTH and chronic TTH (over 15 headache days per month, over 3 month duration) |
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Tension type headache is generally an over diagnosed headache condition. Often what has been considered to be TTH is often migraine. Always consider if the patient has migrainous components to their TTH. If they have it is most likely to be migraine. Typically TTH is a featureless generalised headache of mild to moderate severity. Features of photophobia, phonophobia visual or sensorimotor disturbance are absent. Mild nausea can occur, especially in the setting of analgesic overuse. Profound nausea, or vomiting should not occur. It is often may be associated with other comorbidities such as depression. |
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Non-pharmaceutical Reassurance Address triggers/comorbidities- eg depression, anxiety, analgesic overuse Acupuncture Cognitive behavioural
Pharmaceutical
Tricyclics
Try amitrypiline, nortriptiline or imipramine many be less sedating.
SNRI
SSRI
Practice Points |
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