Headaches: Tension - Managing Tension-Type Headaches

(Page 3)

Headache Diary to Identify Triggers

Keeping a headache diary is a useful way to identify triggers that bring on headaches, and to help the doctor differentiate between migraine and tension-type headache. Be sure to include all events preceding an attack. Often two or more triggers interact to produce a headache.

In general, certain stimuli are able to trigger most types of primary headaches, although people with migraines may be more sensitive to some of them (weather, certain smells, light, and smoke) than people with tension headaches.

Tracking medications is an important way of identifying medication-overuse headache or transformed migraine.

---

---

Be sure to attempt to define the intensity of the headache. There are different scoring symptoms available that help communicate the severity of the pain to the doctor. For instance, the following is a number system that can be helpful:

1 = Mild, barely noticeable

2 = Noticeable, but does not interfere with work/activities

3 = Distracts from work/activities

4 = Makes work/activities very difficult

5 = Incapacitating

Physical Examination

In order to diagnose a chronic headache, the doctor will examine the head and neck to check for muscle tenderness. The doctor may also perform a neurologic examination, which includes a series of simple exercises to test strength, reflexes, coordination, sensation, and mental function. The doctor may also recommend an eye examination.

Imaging Tests

Imaging tests used for severe or persistent headache include computed tomography (CT) scan and magnetic resonance imaging (MRI). Imaging tests of the brain may be recommended under the following circumstances:

• If the results of the history and physical examination suggest neurologic problems
• Changes in vision
• Muscle weakness
• Fever and stiff neck
• Changes in the way someone walks
• Changes in mental status including signs of disorientation

Imaging tests may also be recommended for:

• Patients with headache that wakes them at night
• A sudden or severe headache, or a headache that is the worst headache of someone's life
• For patients with history of cancer or weakened immune system
• For new headaches in adults over 50 years, especially in the elderly. In this age group, it is particularly important to first rule out age-related disorders, including stroke, low blood sugar (hypoglycemia), fluid accumulation in the brain (hydrocephalus), and head injuries (usually from falls).
• For patients with worsening headache or headaches that do not respond to routine treatment