Tests
1st tests to order
clinical diagnosis
Test
A thorough history and physical exam 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 rarely aid in the diagnosis of tension-type headaches.[19] For patients with no red flags and a normal neurologic examination, do not request imaging for patients with a primary headache.[17][20] Studies have demonstrated very few significant structural abnormalities on neuroimaging in patients presenting with tension-type headache.[19]
Patients with a significant likelihood of structural disease requiring immediate attention will be detected by validated clinical screening tools. Incidental findings found on imaging may lead to additional medical procedures and expense that do not improve patient outcomes.[17]
Result
history consistent with typical tension-type headache without associated features (vomiting, or significant nausea, phonophobia, or photophobia); normal neurologic exam; pericranial muscle tenderness may be present
Tests 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 tumor.
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 apnea where symptoms/history are suggestive.
Result
normal
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