Chronic tension-type headache

Abstract

A 42-year-old woman was admitted to the emergency room (ER) for the worsening of a continuous headache. She reported of having very frequent headaches for the last couple of years. Last year she had had headaches every day. Headache severity was mild to moderate, bilateral, starting from back of her head, and spreading to the vertex and forehead. She said she took NSAIDs when the pain is moderate. The pain responds moderately to the NSAIDs. Her blood pressure (BP) was found to be 150/90 mmHg; otherwise, the physical examination was normal. She received a diagnosis of headache secondary to hypertension and was treated accordingly. Her BP returned to normal in an hour and then she was referred to the cardiology hypertension outpatient clinic. There, she was diagnosed with essential hypertension and was given an ACE inhibitor. Five months after the first evaluation, despite that her BP remained normal, her headaches did not improve and she went back to her cardiologist who then referred her to the neurology headache outpatient clinic.