A 27-year-old woman comes to the office due to almost daily headaches for the past 3 months. The patient describes constant "dull pressure" in her head that is worse at the end of the day. She is an office manager and is able to work through the pain. The patient has a history of seasonal allergies and her sister has migraine headaches. Which of the following is the most likely diagnosis?

Question

A 27-year-old woman comes to the office due to almost daily headaches for the past 3 months.  The patient describes constant "dull pressure" in her head that is worse at the end of the day.  She is an office manager and is able to work through the pain.  The patient has a history of seasonal allergies and her sister has migraine headaches.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec160b_39e0_870d_9249_9de7d728b4de_MD0001_00 This woman with dull, near-daily headaches has tension headaches (THs), the most common form of headache. THs are likely due to sensitization of peripheral nociceptors leading to increased perception of myofascial pain. Patients typically develop mild to moderate, achy, or pressure-like pain that is often bilateral and may involve the occipitonuchal, temporal, or frontal regions of the head. Pericranial muscle tenderness (eg, head, neck, shoulder) is common. THs are not associated with other neurologic symptoms or nausea/vomiting and are often precipitated by stress and fatigue. They may persist for days, months, or even years but (unlike migraines and cluster headaches) do not typically limit a patient's ability to perform daily functions. Treatment is typically with simple analgesics (eg, nonsteroidal anti-inflammatory drugs, acetaminophen). (Choice A) Chronic sinusitis can cause facial pain and tenderness but is often associated with nasal congestion and mucopurulent nasal drainage. A reduced sense of smell and taste is also common. (Choice B) Cluster headaches most commonly affect men and present as severe, unilateral, orbital or temporal pain with associated autonomic symptoms (eg, lacrimation, rhinorrhea, diaphoresis). The headaches are typically brief (15-180 minutes), debilitating, and may awaken patients from sleep. (Choice C) Giant cell arteritis is associated with an acute headache that is typically accompanied by scalp tenderness, visual symptoms, and jaw claudication. It occurs exclusively in older patients (age ≥50) and is often associated with polymyalgia rheumatica. (Choice D) Brain tumors typically cause nausea, vomiting, and headaches that worsen with changes in body position. In addition, the presence of other focal neurologic signs would be expected due to compression of surrounding brain structures by the expanding tumor. (Choice E) Migraine headaches are characterized by often debilitating, episodic, unilateral, pulsatile headaches typically associated with nausea, photophobia, and phonophobia. Some patients have focal neurologic symptoms that precede or accompany the headache (ie, aura). Educational objective: Tension headaches are the most common form of headache. They are characterized by an achy or pressure-like pain that is often bilateral and associated with pericranial muscle tenderness. Tension headaches are not associated with other neurologic symptoms and do not typically limit a patient's ability to perform daily functions.

A 27-Year-Old Woman Comes to the Office Due to Almost