Tension headache



Tension headache

Nervous system


Tension headache


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USMLE® Step 1 questions

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High Yield Notes

6 pages


Tension headache

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USMLE® Step 1 style questions USMLE

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A 30-year-old woman comes to the office due to daily headaches for the past few months. She describes the location to be all the way around her head, and she feels like her head is under a lot of pressure. She rates the pain as a 5 on a 10-point scale, and it often worsens in severity throughout the day. She works as a secretary, and she states that she has been under a lot of stress lately. Her medical history is significant for bacterial sinusitis treated with antibiotics one month ago, and family history is significant for migraines on her mother's side. Temperature is 37.0°C (98.6° F), pulse is 65/min, and blood pressure is 115/75 mm Hg. Physical examination shows mild tenderness on palpation of her posterior neck and occiput. Which of the following is the most likely diagnosis?  

External References

First Aid








Acetaminophen p. 498

tension headaches p. 536

Amitriptyline p. 599

tension headaches p. 536

Tension headaches p. 536


Tension headache or tension-type headache is the most common type of primary headache. Tension-type headache pain is often described as constant pressure as if the head were being squeezed in a vise. The pain can radiate from the lower back of the head, neck, eyes, or other muscle groups in the body and typically affects the head bilaterally. They usually occur for a duration longer than 30 minutes, typically four to six hours.

The exact cause of tension headaches is well understood, but factors that can trigger or exacerbate tension headaches include stress, anxiety, poor posture, fatigue, and eye strain. Treatment options for tension headaches may include pain relievers, such as ibuprofen or acetaminophen, and stress management techniques, such as relaxation exercises, biofeedback, or cognitive-behavioral therapy.


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