Care Pathway for the Management of Episodic Tension-type Headaches

Conduct an appropriate clinical evaluation to rule out major structural or other pathologies as the cause of the symptoms.
Risk factors/red flags may include:
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worsening headache with fever
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sudden-onset headache (thunderclap) reaching maximum intensity within 5 minutes
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new onset neurological deficit
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new onset cognitive dysfunction
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change in personality
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impaired level of consciousness
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recent (within the last 3 months) head trauma
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headache triggered by exertion (e.g. cough, valsalva maneuver, sneeze, exercise)
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headache that changes with posture
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symptoms suggestive of giant cell arteritis
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symptoms and signs of acute narrow-angle glaucoma
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a substantial change in the characteristics of the patient's headache
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new onset or change in headache of patients who are over 40 years of age and older
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headache wakening the patient up (migraine is the most frequent cause of morning headache)
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patients with risk factors for cerebral venous sinus thrombosis
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jaw claudication or visual disturbance
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neck pain or stiffness
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limited neck flexion upon examination
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new onset headache in patients with a history of human immunodeficiency virus (HIV) infection
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new onset headache in patients with a history of cancer
No
No
No
Yes
Management of Symptoms
Based on shared decision making between the patient and provider, any one of the following therapeutic interventions is recommended:
Yes
Yes
No
Discharge
Yes
Yes
Discharge
No