Table of contents
Tension-type headache
What's new
Updated 2024 VA/DoD guidelines for the management of tension-type headache.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of tension-type headache are prepared by our editorial team based on guidelines from the United States Department of Defense (DoD/VA 2024), the American College of Radiology (ACR 2023), the American Academy of Family Physicians (AAFP 2022,2020,2018,2014), the European Federation of Neurological Societies (EFNS 2010), and the The Scottish Intercollegiate Guidelines Network ...
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Diagnostic investigations
History and physical examination
As per AAFP 2020 guidelines:
Obtain a complete clinical assessment in patients with frequent or increasing headaches, even in patients with long-standing headaches, as a new headache type may have developed or the current diagnosis may be inaccurate.
B
Assess for medication overuse in all patients with frequent or increasing headaches.
B
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Diagnostic imaging
Diagnostic procedures
Medical management
Acute therapy
As per DoD/VA 2024 guidelines:
Consider offering ibuprofen 400 mg or acetaminophen 1,000 mg for the short-term treatment of tension-type headache.
C
Insufficient evidence to recommend for or against IV antiemetics (chlorpromazine, metoclopramide, prochlorperazine), IV magnesium, or intranasal lidocaine for the short-term treatment of headache.
I
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Prophylactic therapy (indications)
Prophylactic therapy (antidepressants)
Prophylactic therapy (botulinum toxin)
Prophylactic therapy (other agents)
Nonpharmacologic interventions
Therapeutic procedures
Neuromodulation: as per DoD/VA 2024 guidelines, insufficient evidence to recommend for or against any of the following forms of neuromodulation for the treatment and/or prevention of migraine:
noninvasive vagus nerve stimulation
supraorbital, or external trigeminal, nerve stimulation
remote electrical neurostimulation
external combined occipital and trigeminal neurostimulation system
repetitive transcranial magnetic stimulation
transcranial direct current stimulation.
I
Specific circumstances
Pregnant patients, evaluation
As per ACR 2023 guidelines:
Obtain MRI or CT in patients with new-onset or a new pattern of headache during pregnancy or the peripartum period.
B
Consider obtaining MRV without IV contrast or CTV with IV contrast given the specific clinical scenario.
C
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Pregnant patients (management)