A 70-years-old retired military person with good previous medical record complains of bi-temporal headache which is decreased in lying down position. He states that he gets relief by giving pressure over bilateral temples. The patient also complains of loss of appetite with feeling feverish. Diagnosis is:
**Core Concept**
Chronic tension headache is a type of primary headache disorder characterized by sustained or episodic band-like pressure or tightening around the forehead, often accompanied by bilateral temporal tenderness, which is exacerbated by physical activity and relieved by rest.
**Why the Correct Answer is Right**
The patient's symptoms, including bi-temporal headache, relief with pressure over bilateral temples, and improvement in the lying down position, are classic features of chronic tension headache. This condition is often related to stress, anxiety, or muscle tension, which can cause sustained contraction of the scalp and neck muscles, leading to pain. The patient's loss of appetite and feeling feverish may be secondary to the chronic stress and anxiety associated with this condition.
**Why Each Wrong Option is Incorrect**
**Option B:** Temporal arteritis, also known as giant cell arteritis, typically presents in older adults with sudden, severe headache, often accompanied by visual disturbances, jaw claudication, and systemic symptoms like fever. The patient's symptoms do not match this condition.
**Option C:** Migraine is a neurological disorder characterized by recurrent episodes of severe headache, often accompanied by nausea, vomiting, and sensitivity to light and sound. The patient's symptoms do not align with the typical presentation of migraine.
**Option D:** Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and tender points, often accompanied by sleep disturbances and cognitive difficulties. While fibromyalgia can cause headache, the patient's symptoms do not match the typical presentation of this condition.
**Clinical Pearl / High-Yield Fact**
Chronic tension headache is often associated with stress, anxiety, or muscle tension, and patients may benefit from stress management techniques, such as relaxation therapy, biofeedback, or cognitive-behavioral therapy, in addition to pharmacological treatment.
**Correct Answer Line**
✓ Correct Answer: A. Chronic tension headache