Tension-Type (Muscle Contraction) Headache

Presentation

The patient complains of a dull, steady (nonpulsating) pain, described as a pressing, tightening, squeezing, or constricting band, located bilaterally anywhere from the eyes to the occiput, perhaps including the neck or shoulders. Often the headache is a bilateral tightness or sensation of pressure around the temples. Most commonly, the headache develops near the end of the day or after some particularly stressful event. The severity should progress gradually and not achieve maximum intensity within seconds to minutes of onset. There is usually no photophobia, nausea, or vomiting, although photophobia and phonophobia can occur (but not both), and the patient may have a loss of appetite. These headaches may also be associated with fatigue. Tension-type headache pain can last from 30 minutes to several days and can be continuous in severe cases. It is classified as infrequent episodic (<1 day per month), frequent episodic (1–14 days per month), or chronic (>15 days per month, occurring with or without muscle spasm). The pain may improve with rest or administration of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or other medications. The physical examination should be unremarkable, except for possible cranial or posterior cervical muscle spasm or tenderness and difficulty relaxing.