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Tension Headache (cont.)

When to Seek Medical Care

When to call the doctor

  • People with episodic or chronic tension-type headache who experience a change in severity or frequency should consult with a doctor.
  • People without a history of headache who are older than 50 years and experience pain in the temporal region (near the temple on the head) should see a doctor to be evaluated for temporal arteritis. In addition, those older than 50 years with new-onset headache should be evaluated for possible malignancy.
  • When headache is associated with signs of infection, such as fever, rash, or stiff neck, a doctor should be seen to rule out conditions like meningitis, encephalitis, or Lyme disease.
  • Persons with new-onset headache who either have risk factors for HIV infection, or who have HIV infection or cancer, may need imaging studies to rule out meningitis, brain abscess, or the spread of cancer.

When to go to the hospital

Certain headaches may indicate a more serious underlying problem. In these cases, the person should seek immediate medical attention at a hospital emergency department.

  • People who may or may not have a history of headache and feel they are experiencing the worst headache of their life should seek emergency help, especially if the headache feels "explosive" and came on suddenly. This may suggest bleeding within or around the brain. The sudden onset, not necessarily the severity of the pain, is a signal that people with such headaches should be checked.
  • People with headache and other associated symptoms, such as loss of vision in one eye, weakness on one side of the body, slurring or garbled speech, or inability to understand and follow commands, should be evaluated at once.
  • Any person, but especially an elderly person, who sustains any form of trauma associated with the onset of headache must be evaluated in an emergency department.

Exams and Tests

Most tension-type headaches are diagnosed based on a complete and comprehensive history and physical examination. No further diagnostic studies are needed for people who have normal neurological examination findings and are otherwise healthy.

In contrast, people with chronic tension-type headache, regardless of whether they have normal neurological examination findings, should have a CT scan and MRI. Although this sophisticated imaging does not diagnose a specific type of headache syndrome, it may prove invaluable in excluding other causes of the headaches. Thyroid function studies, complete blood cell count, and metabolic screening should also be performed.

Medically Reviewed by a Doctor on 8/20/2014
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