Rural orientation Preventive and social Medicine

CHAp

1. Tutorial- Case 3 Group 3

2. 40 year old female with past medical history of depression presents with headache since 3 years which starts in back of her neck and moves to forehead. Pain is described as tightening band around her forehead. There is no history of photophobia, phonophobia, nausea, vomiting. Headache persisted for more than 4-5 hours

3. What is your diagnosis ? Tension-type headache Chronic head- pain syndrome characterized by Bilateral tight, band-like discomfort . Pain typically builds slowly, fluctuates in severity, persists more or less continuously for many days. May be episodic or chronic(>15 days per month) A useful cilinical approach is to diagnose TTH in patients whose headaches are completely without accompanying features such as Nausea , vomiting, photophobia, phonophobia , osmophobia , throbbing, aggravation with movement

4. Site : Frontal, over forehead and temples Radiates to the occiput Dull ache, like a “tight band around head”, “tight pressure feeling”, “heavy weight on top of head Onset : after rising, gets worse during day Aggravating factors : stress, overwork with skipping meals Can present with muscle tension (frowning), scalp often tender to touch

5. Pathophysiology of the disease? Incompletely understood Some consider that some milder version of migraine. Original notion was that it is primarily due to muscle tension in the neck and scalp region. Anxiety about the headache itself may lead to continuation of headache.

6. How to manage this case? Reassurance and patient education. Stress reduction - Behavioral approaches including relaxation can also be effective. Pain can generally be managed with simple analgesics like acetaminophen, aspirin or NSAIDS. Triptans only effective in TTH when patient also has migraine. For chronic TTH, amitriptyline is effective.