紧张型头痛是最常见的一种原发性头痛。它通常表现为轻度至中度的、持续的、带状的疼痛或压迫感，涵盖前额或头部和颈部后部。这种头痛经常被描述为头部有一种紧箍的感觉，通常不会因日常体力活动而加剧。紧张型头痛可以是偶发的或慢性的，偶发型发作频率较低，而慢性型则更为持续。紧张、焦虑和肌肉紧张常与紧张型头痛的发作相关。

症状：
• 紧张型头痛通常表现为持续的、带状的痛感或压力，常围绕前额，通常被描述为影响头部两侧的“紧绷”感觉。其强度通常为轻至中度，且不会因日常体力活动而加剧。
• 这类头痛还可能包括头皮、颈部和肩部肌肉的触痛。

病史：
• 头痛的频率、持续时间及强度。
• 对非处方止痛药的反应。
• 任何压力、焦虑或抑郁的历史。
• 睡眠模式及任何近期的生活方式或饮食变化。

体格检查：
• 检查主要集中在排除其他头痛原因。包括检查颈部、肩部和头部周围肌肉的触痛迹象。
• 神经系统检查以排除其他神经系统异常。

诊断测试：
• 如果紧张型头痛符合临床模式且没有警示性特征，通常不需要诊断测试。
• 如果头痛模式改变，或存在非典型症状或体征，可能需要进行进一步的诊断测试，如MRI或CT扫描，以排除其他原因。

1. 病史收集:
• 患者常描述头痛为持续的、钝感的压迫或紧绷感，通常被形容为“带状”的感觉。
• 头痛通常是双侧的，并且在常规体力活动中不会加剧。
• 他们可能报告压力、焦虑或睡眠不足等触发因素。

2. 体格检查:
• 通常正常；观察不到神经系统缺损。
• 头部和颈部的检查可能会发现头皮、颈部和肩部的肌肉触痛。

3. 诊断测试:
• 紧张型头痛通常不需要特定的诊断测试，因为它主要基于临床标准来诊断。
• 如果头痛模式改变或出现非典型症状，可能会进行 MRI 或 CT 扫描等进一步调查，以排除其他原因。

紧张型头痛患者病历示例
• 症状: 患者报告频繁出现额头和太阳穴部位的钝痛和压迫感。这些头痛通常持续30分钟到几天不等。痛感轻度至中度，体力活动不会加剧痛感。没有恶心或呕吐，但患者报告对光或声音有轻微敏感。
• 病史: 患者有工作压力大和睡眠不规律的历史。患者及家族中没有偏头痛或丛集头痛的历史。没有重要的既往医疗或手术史。
• 体格检查: 检查中未发现神经功能异常。颈部肌肉无压痛，无鼻窦炎或颞动脉炎迹象。
• 鉴别诊断所需的诊断测试:
• 血液检查: 排除可能引起头痛的感染或炎症。
• 脑部MRI: 排除肿瘤或脑积水等结构性脑部异常。
• 眼科检查: 检查屈光不正或青光眼等可能导致头痛的问题。

一位典型的紧张型头痛患者可能如下描述：一名30岁女性报告称她经历双侧头部的钝痛和压迫感，形容这种感觉像是头部被紧箍着一样。这种头痛通常在工作日的末尾发生，持续时间从30分钟到几天不等。她否认有恶心或畏光的症状，但提到对噪音更加敏感。患者还报告工作压力大和睡眠模式不佳。非处方止痛药只能提供轻微缓解。患者过去的病史没有显著问题。

在鉴别诊断紧张型头痛时，应排除一些可能表现出类似症状的其他疾病。这些包括：
1. 偏头痛 - 通常表现为跳动性疼痛，常为单侧，并可能伴有恶心、呕吐以及对光或声音的敏感。
2. 簇状头痛 - 以严重的燃烧感疼痛为特点，通常围绕一只眼睛或太阳穴，并可能伴有眼部红肿、流泪和鼻塞。
3. 药物过量头痛 - 由于频繁使用头痛药物引起的头痛，随时间推移可能会加剧或变得更频繁。
4. 鼻窦炎 - 鼻窦腔的炎症，可以引起类似头痛的疼痛，常伴有面部压力感或充血。
5. 巨细胞动脉炎 - 一种血管炎症性疾病，可引起头痛、头皮压痛、下颌痛及视觉问题，通常见于老年人。
6. 颅内高压 - 颅内压力增高可引起头痛及视觉障碍等神经系统症状。
7. 脑瘤 - 虽然罕见，但脑瘤可以表现为头痛及其他神经功能缺失。
这些情况应根据临床评估和必要时的进一步诊断测试来考虑和适当排除。

Tension-type headache is the most common type of primary headache. It presents as a mild to moderate, constant band-like pain or pressure around the forehead or back of the head and neck. Often described as feeling like a tight band around the head, these headaches are not typically worsened by routine physical activity. They can be episodic or chronic, with episodic occurring less frequently and chronic being more persistent. Stress, anxiety, and muscle strain are frequently associated with the onset of tension-type headaches.

Symptoms:
• Tension-type headache typically presents as a constant, band-like pain or pressure around the forehead, often described as a "tightening" feeling that affects both sides of the head. It's usually mild to moderate in intensity and does not worsen with routine physical activity.
• These headaches may also include tenderness in the scalp, neck, and shoulder muscles.

Medical History:
• The frequency, duration, and intensity of headaches.
• Response to over-the-counter pain relief medications.
• Any history of stress, anxiety, or depression.
• Sleep patterns and any recent changes in lifestyle or diet.

Physical Examination:
• Examination primarily focuses on ruling out other causes of headache. This includes checking for signs of muscle tenderness around the neck, shoulders, and head.
• Neurological examination to rule out other neurological abnormalities.

Diagnostic Tests:
• Typically, tension-type headaches do not require diagnostic tests if they fit the clinical pattern and have no alarming features.
• If the headache pattern changes, or if atypical symptoms or signs are present, further diagnostic tests such as MRI or CT scans might be needed to exclude other causes.

In the case of tension-type headaches, here are common findings from medical history taking, physical examinations, and diagnostic tests:

1. Medical History:
• Patients often describe the headache as a constant, dull pressure or tightness around the head, commonly referred to as a "band-like" sensation.
• The headaches are usually bilateral and do not worsen with routine physical activity.
• They can report triggers such as stress, anxiety, or lack of sleep.

2. Physical Examination:
• Typically normal; there are no neurological deficits observed.
• The examination of the head and neck might reveal muscle tenderness in the scalp, neck, and shoulders.

3. Diagnostic Tests:
• Generally, no specific diagnostic tests are required for tension-type headaches as they are primarily diagnosed based on clinical criteria.
• If the headache pattern changes or if atypical symptoms arise, further investigations like an MRI or CT scan might be conducted to rule out other causes.

Medical Record Example for Tension-Type Headache
• Symptoms: Patient reports frequent episodes of a dull, pressing pain in the forehead and temples. These headaches typically last from 30 minutes to several days. The pain is described as mild to moderate and does not worsen with physical activity. There is no nausea or vomiting, but the patient reports mild sensitivity to light or noise.
• Medical History: Patient has a history of stress at work and irregular sleep patterns. No history of migraines or cluster headaches in the patient or family. No significant past medical or surgical history.
• Physical Examination: Examination shows no abnormalities in neurological function. No tenderness in the neck muscles, and no signs of sinusitis or temporal arteritis.
• Diagnostic Tests Required for Differential Diagnosis:
• Blood Tests: To rule out infections or inflammation that could cause headaches.
• MRI of the Brain: To exclude structural brain abnormalities such as tumors or hydrocephalus.
• Eye Examination: To check for refractive errors or glaucoma, which could contribute to headaches.

A typical patient with a tension-type headache might present as follows: A 30-year-old female reports experiencing dull, pressing pain on both sides of her head, describing it as a sensation of a tight band around her head. These headaches occur frequently, especially towards the end of a workday, and may last from 30 minutes to several days. She denies nausea or photophobia but mentions increased sensitivity to noise. The patient also reports stress at work and poor sleep patterns. Over-the-counter pain relievers provide only mild relief. There is no significant past medical history of note.

In the differential diagnosis of tension-type headache, it is important to rule out several other conditions that can present with similar symptoms. These include:
1. Migraine - Often characterized by pulsating pain, usually unilateral, and may be accompanied by nausea, vomiting, and sensitivity to light or sound.
2. Cluster Headaches - Known for their severe, burning pain typically around one eye or temple, with associated symptoms like eye redness, tearing, and nasal congestion.
3. Medication Overuse Headache - Headaches arising from the frequent use of headache medications, which can worsen or become more frequent over time.
4. Sinusitis - Inflammation of the sinus cavities, which can cause pain similar to a headache, often with facial pressure or congestion.
5. Giant Cell Arteritis - An inflammatory disease of blood vessels that can cause headaches, scalp tenderness, jaw pain, and vision problems, typically in older adults.
6. Intracranial Hypertension - Increased pressure inside the skull can lead to headaches along with visual disturbances and other neurological symptoms.
7. Brain Tumors - Though rare, brain tumors can manifest as headaches along with other neurological deficits.

These conditions should be considered and appropriately ruled out based on clinical evaluation and, when indicated, further diagnostic testing.