Evaluation and management of the muscle contraction headache.

Headache was the seventh most frequent reason for a visit to primary care providers specified in the 1977-1978 National Ambulatory Care Survey. Muscle contraction headaches (MCH) constitute 90 percent of all headaches. Following a discussion of the epidemiology of headache, this article describes the pathophysiology, history, psychological profile of the typical MCH patient, common objective findings of MCH versus intracranial mass, physical findings and diagnosis. The management section includes a discussion of education and appropriate pharmacologic treatment, along with non-pharmacologic treatments such as massage, acupressure, biofeedback and stress management. Acupuncture is briefly described. Referral criteria for the MCH is included.