Term
| What are the key clinical features of tension headache? |
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Definition
- Location: Bilateral, band-like pressure around the forehead or back of the head/neck.
- Character: Dull, non-throbbing ache (often described as "just pain").
- Duration: Episodic (less than 15 days/month) or chronic (≥15 days/month).
- Triggers: Stress, dehydration, skipped meals, poor posture, lack of exercise.
- Absence of red flags: No nausea, photophobia, vision changes, or neurological deficits.
- Associated symptoms: Tight neck muscles, pressure behind the eyes.
Why this matters: These features help differentiate tension headache from migraines, meningitis, or space-occupying lesions. |
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Term
| How would you differentiate tension headache from a migraine? |
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Definition
- Tension headache:
- Bilateral, non-pulsating pain.
- No nausea/vomiting or aura.
- Mild-moderate intensity.
- Aggravated by stress, relieved by relaxation.
- Migraine:
- Unilateral, throbbing pain.
- Associated with nausea, photophobia, phonophobia.
- Moderate-severe intensity.
- May have aura (e.g., visual disturbances).
Why this matters: Misdiagnosis can lead to inappropriate treatment (e.g., triptans for tension headaches). |
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Term
| What red flags for serious pathology would you screen for in a headache history? |
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Definition
- "SNOOP4" Mnemonic:
- S ystemic symptoms (fever, weight loss).
- N eurological deficits (weakness, slurred speech).
- O nset sudden/thunderclap (e.g., subarachnoid hemorrhage).
- O lder age (>50, new-onset headache).
- P attern change (worsening frequency/severity).
- P recipitated by Valsalva (coughing/sneezing).
- P apilledema or visual changes.
- Specific examples from the case:
- Neck stiffness (meningitis).
- Trauma, vision loss, or focal neurological signs.
Why this matters: Red flags warrant urgent imaging or referral (e.g., CT for suspected SAH). |
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Term
| What first-line non-pharmacological treatments would you recommend for tension headache? |
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Definition
- Stress management: Yoga, meditation, deep breathing.
- Physical therapies: Neck/shoulder massage, warm/cool compresses.
- Lifestyle adjustments:
- Regular hydration and meals.
- Exercise (e.g., 30 mins of walking daily).
- Posture correction (e.g., ergonomic workspace).
- Preventive strategies:
- Keep a headache diary to identify triggers.
- Acupuncture (evidence-supported for chronic cases).
Why this matters: Reduces reliance on analgesics and addresses underlying triggers like stress. |
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Term
| A patient insists on a CT scan. How would you respond? |
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Definition
Q5: A patient insists on a CT scan. How would you respond?
A5:
1. Acknowledge concern: "I understand you want to rule out serious causes."
2. Explain risks: "CT scans involve radiation, which increases cancer risk with repeated use."
3. Clinical reassurance: "Your history/exam lack red flags (e.g., no vision changes or neurological signs), so a scan isn’t necessary."
4. Offer alternatives: "Let’s focus on managing triggers and tracking symptoms with a diary."
Why this matters: Unnecessary imaging increases healthcare costs and patient anxiety. PLAB 2 emphasizes shared decision-making. |
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Term
| What advice would you give about painkiller use in tension headaches? |
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Definition
- Short-term use: Paracetamol or ibuprofen for ≤3 days/week.
- Avoid overuse: >10 days/month can cause medication-overuse headaches.
- Caution with caffeine: Avoid combination analgesics (e.g., codeine) due to dependency risk.
- Monitor frequency: If headaches persist, revisit non-pharmacological strategies.
Why this matters: Overuse worsens headaches and complicates management. |
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Term
| How would you explain tension headaches to a patient? |
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Definition
- Simple analogy: "It’s like a tight band around your head, often from muscle tension or stress."
- Reassurance: "It’s not dangerous but can affect quality of life."
- Pathophysiology: "Stress or poor posture tightens neck/scalp muscles, causing pain."
- Prognosis: "Most improve with lifestyle changes and occasional painkillers." |
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Term
| What lifestyle modifications help prevent tension headaches? |
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Definition
- Hydration: 6–8 glasses of water daily.
- Regular sleep: Consistent sleep schedule.
- Ergonomics: Adjust desk/chair to avoid neck strain.
- Exercise: Aerobic activity (e.g., swimming) 3–5x/week.
- Caffeine reduction: Limit to ≤2 cups/day to prevent rebound headaches.
Why this matters: Addresses modifiable triggers and reduces recurrence. |
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Term
| When would you consider chronic tension headache? |
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Definition
- Diagnostic criteria:
- Headaches ≥15 days/month for >3 months.
- Lasting hours to days.
- No underlying pathology (e.g., normal exam, no red flags).
- Management:
- Amitriptyline (low-dose) for prophylaxis.
- Cognitive-behavioral therapy (CBT) for stress. |
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Term
| How would you address a patient’s concern about "serious brain disease"? |
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Definition
- Empathize: "It’s natural to worry, but let me explain why I’m confident it’s not serious."
- Clinical evidence: "No red flags like vision changes, fever, or sudden onset."
- Reinforce diagnosis: "Your symptoms align with tension headaches, which are common and manageable."
- Open dialogue: "Let’s monitor together and revisit if anything changes."
Why this matters: Builds trust and reduces patient anxiety without unnecessary tests. |
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Term
| Safety Netting for tension headache. |
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Definition
| : "Return if you develop vomiting, vision changes, or sudden worsening." |
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