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Source: Minor DS, Harrell TK. Headache disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146063736. Accessed May 16, 2017.
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CONDITION/DISORDER SYNONYMS
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Pain originates from myofascial factors and peripheral sensitization of nociceptors as well as central mechanisms also involved.
After activation of supraspinal pain perception structures, headache occurs because of central modulation of incoming peripheral stimuli.
Initiating stimuli may include:
In predisposed individuals, chronic tension-type headache can evolve from episodic tension-type headache.
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Most common type of primary headache.
One-year prevalence ranges from 38% to 86%.
Prevalence peaks in fourth decade and is higher among women.
Incidence decreases with age.
Infrequent episodic tension-type headache (<1 episode per month) experienced by 64%, whereas 22% have frequent episodic tension-type headache (episodes on 1–14 days per month).
Prevalence of chronic tension-type headache (≥15 days per month): 0.9–2.2%.
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CLINICAL PRESENTATION
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Pain usually mild to moderate, bilateral, nonpulsatile tightness or pressure, and in frontal and temporal areas; occipital and parietal areas can also be affected.
Mild photophobia or phonophobia may occur.
Pericranial or cervical muscles may have tender spots or localized nodules.
No premonitory symptoms or aura.
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DIFFERENTIAL DIAGNOSIS
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Rapid headache relief with minimal adverse effects.
Minimal disability and emotional distress.
Avoidance of emergency department or physician office visits.
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TREATMENT: GENERAL APPROACH
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TREATMENT: NONPHARMACOLOGIC THERAPY
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Stress management.
Relaxation training.
Biofeedback.
Physical options (eg, heat or cold packs, ultrasound, electrical nerve stimulation, massage, acupuncture, manipulations, ergonomic instruction, trigger point injections, and occipital nerve blocks) have inconsistent results.
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TREATMENT: PHARMACOLOGIC THERAPY
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