This patient typically presents with a chief complaint of head pain described as a tight band around his head that may be heavy or oppressive. In tension headache, the pain is most often described as being on both sides of the head, and there may be some referred pain to the patient’s neck.
Getting a handle on how much head pain a patient is experiencing may be extremely difficult. A good assessment for head pain is to note the patient’s activity level. Patients experiencing a tension headache will be able to perform what are known as activities of daily living (ADL), such as getting out of bed, walking around the house, and descending or ascending stairs, without the pain interfering or limiting these activities. It doesn’t mean they don’t have pain; it is just an indicator of pain severity and that their activity does not increase the pain.
It is not uncommon for a patient with a severe tension headache to also complain of nausea and vomiting, which often leads to a 9-1-1 call. The patient may have a history of tension headache, but has never experienced nausea or vomiting with it. It is not uncommon for this patient to complain of sensitivity to light (photophobia) or sound (hyperacusis), but not both.
As the name implies, tension headache is due to muscle tension. Characteristically, the muscles of the head and neck have contracted very tightly for a prolonged period of time, due to physical exertion, reading intensively, poor posture, work habits, or, of course, retaining stress. Most individuals, EMSers included, will experience episodic tension headaches; however, some may experience tension headache on a more frequent basis. People who have tension headache greater than 15 days a month are considered to have chronic tension headache.1
The majority of folks who experience a tension headache find relief with over-the-counter (OTC) pain medications like ibuprofen, acetaminophen or aspirin. Cold compresses, stopping the activity (e.g., reading, posture change), along with relaxation activities may also provide relief for the individual.
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