Investigations
1st investigations to order
clinical diagnosis
Test
A thorough history and physical examination should be undertaken. Headache diaries can be used to aid diagnosis and guide clinical decision-making. They allow patients to report clinical headache features (such as frequency, onset, duration, and characteristics) and accompanying symptoms.[3] Imaging and laboratory studies do not aid in the diagnosis of tension-type headaches and should only be considered in refractory or progressive cases.
Result
history consistent with typical tension-type headache without associated features (vomiting, or significant nausea, phonophobia, or photophobia); normal neurological examination; pericranial muscle tenderness may be present
Investigations to consider
CT sinus
Test
May be considered in cases of refractory or progressive headaches to exclude sphenoid sinusitis.
Result
normal
MRI brain
Test
May be considered in cases of refractory or progressive headaches to exclude a brain tumour.
Result
normal
lumbar puncture
Test
May be considered in cases of refractory or progressing headaches to exclude infective causes (e.g. brain abscess, meningitis, encephalitis), sinus venous thrombosis, or idiopathic intracranial hypertension. Cerebrospinal fluid opening pressure can be measured to rule out idiopathic intracranial hypertension or spontaneous intracranial hypotension.
Result
normal
polysomnography
Test
May be considered in cases of refractory or progressive headaches to exclude sleep apnoea where symptoms/history are suggestive.
Result
normal
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