Name of the Condition

• Chronic tension-type headache, intractable
  
  • Common names: Chronic tension headaches, Persistent tension headache

Summary

Chronic tension-type headache (TTH) is a persistent form of headache characterized by a continuous and dull pressure or tightness around the forehead or back of the head and neck. The term "intractable" indicates that these headaches are resistant to treatment and difficult to manage.

Causes

The exact cause of chronic tension-type headaches is not well understood but may involve muscle tension, stress, or brain chemical imbalances. Factors such as prolonged muscle contraction and changes in how the brain perceives pain are also considered potential causes.

Risk Factors

• High levels of stress or anxiety
• Poor posture
• Sleep disturbances
• Excessive muscle tension
• Family history of chronic headaches

Symptoms

• Persistent, dull, and aching head pain
• Sensation of tightness or pressure across the forehead or on the sides and back of the head
• Tenderness of scalp, neck, and shoulder muscles
• Difficulty concentrating

Diagnosis

• Clinical evaluation through detailed medical history and physical examination
• Exclusion of other headache disorders or underlying medical conditions using imaging techniques (e.g., MRI or CT scan)

Treatment Options

• Medications: Pain relievers (e.g., NSAIDs), antidepressants, anticonvulsants
• Therapies: Cognitive-behavioral therapy (CBT), biofeedback, stress management techniques
• Lifestyle Adjustments: Improved posture, ergonomic adjustments, regular physical activity

Prognosis and Follow-Up

While intractable tension-type headaches can be challenging to treat, a combination of therapies and lifestyle changes can help manage symptoms. Regular follow-ups with healthcare providers are crucial to monitor the condition and adjust treatment plans.

Complications

• Decreased quality of life and productivity
• Psychological issues such as anxiety or depression
• Medication overuse headache from chronic pain treatment

Lifestyle & Prevention

• Regular exercise and relaxation techniques, such as yoga or meditation
• Maintaining a balanced diet and hydration
• Ensuring adequate sleep and adhering to a regular sleep schedule
• Avoidance of known stressors

When to Seek Professional Help

• If headache patterns change or worsen
• If headaches are accompanied by other symptoms such as vision problems or weakness
• If over-the-counter medication is needed more than twice a week

Additional Resources

• American Headache Society (headaches.org)
• National Headache Foundation (headaches.org)

Tips for Medical Coders

• Ensure the chronicity and intractable nature of the headache are documented to accurately assign ICD code G44.221.
• Avoid common errors such as confusing with "episodic" or "non-intractable" tension-type headaches, which have different codes.