Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Tension Headache


Related Terms

  • Tension-type Headache

Differential Diagnosis

  • Anoxia
  • Brain abscess
  • Caffeine dependency
  • Cervical spondylosis
  • Dental disease
  • Depression
  • Encephalitis
  • Fever
  • Glaucoma, acute angle-closure
  • Headache, cluster
  • Headache, migraine
  • Hepatic disorders
  • Hypertension
  • Hypoxia
  • Lesions of the eye or middle ear
  • Lesions of the oral cavity
  • Meningitis
  • Nonprescription analgesic dependency
  • Otitis media
  • Paget's disease of the bone
  • Refractive error
  • Severe anemia or polycythemia
  • Sinusitis
  • Stroke, hemorrhagic
  • Stroke, ischemic
  • Subarachnoid hemorrhage
  • Subdural hematoma
  • Temporal arteritis
  • Temporomandibular joint syndrome
  • Toxic effects form drugs or fumes (carbon monoxide)
  • Trigeminal neuralgia
  • Tumor
  • Uremia

Specialists

  • Clinical Psychologist
  • Neurologist
  • Occupational Therapist
  • Physical Therapist

Comorbid Conditions

  • Anxiety disorders
  • Cluster headaches
  • Complex headaches
  • Migraine headaches
  • Muscular dysfunction

Factors Influencing Duration

The severity of the symptoms and the individual's physical and mental health as well as response to treatment are factors that might influence length of treatment and the need for brief workplace accommodations.

Medical Codes

ICD-9-CM:
307.81 - Special Symptoms or Syndromes, Not Elsewhere Classified; Tension Headache
339.10 - Tension type headache, unspecified
339.11 - Episodic tension type headache
339.12 - Chronic tension type headache

Overview

Tension headache is a chronic headache syndrome that is mild to moderate in severity, occurs on both sides of the head, does not usually become worse with physical exertion, and lasts from less than 1 hour to as long as 7 days.

The exact cause of tension headache is unknown, but possible causes are abnormal muscle contractions in the head and neck or lack of reflex in the muscles located near the temples of the head. A tension headache that lasts from 30 minutes to a week is termed episodic; frequent episodic tension headaches occur fewer than 15 days a month for 3 months at a minimum. A tension headache that lasts for more than 15 days per month for up to 6 months is termed chronic tension headache.

Incidence and Prevalence: Tension headache occurs in roughly 69% of males and 88% of females during their lifetimes. It is the most common primary headache syndrome (in which headache and associated features occur without an exogenous cause) (Singh). In a Danish study, 69% of males and 88% of females reported symptoms of tension headache (Singh).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for tension headache and chronic tension headache include stress, lack of sleep, migraine headaches, mood disorders, muscle strain, muscular dysfunction, and anxiety.

Females are predisposed to getting tension headaches, although both sexes experience tension headaches. In general, about 60% of headaches occur in individuals older than 20 years old (Blanda).

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of a headache that feels like it is "pressing" or "tightening" on both sides of the head or down the back of the head into the neck and shoulders. The individual may complain of being abnormally sensitive either to sound (phonophobia) or light (photophobia), but has no nausea or vomiting. Some authorities suggest diagnosing tension headache only when headaches are not accompanied by photophobia, phonophobia, an abnormal fear of odors (osmophobia), nausea, vomiting, throbbing, and worsening with movement. The individual may also complain of life stressors, lack of sleep, muscular pain or dysfunction, or feeling anxious. Usually the headaches last from 30 minutes to 7 days. Individuals may also experience mild emotional difficulty, trouble concentrating, and muscular pain and tightness. The headache may be worsened by physical activity that tightens muscles in the neck, occipital, and frontal regions. Usually individuals report fewer than 10 previous headache episodes and no more than 180 days per year with headaches. However, about 75% of individuals with chronic tension headaches experience them with relative frequency for greater than 5 years (Blanda).

Physical exam: The individual may appear to be in pain and anxious. It is important to ask questions about the type and duration of pain, and discussion of risk factors aids in the diagnosis. The individual may have a tender scalp or neck; otherwise, the physical exam should be normal.

Tests: Head computed tomography (CT) or magnetic resonance imaging (MRI) can be helpful in ruling out other neurological problems that may cause headaches.

Source: Medical Disability Advisor



Treatment

Risk factors should be identified and decreased, or alleviated, if possible.

Relaxation, massage of the head and neck, hot compresses to the head, and nonprescription medications (in the majority of cases) are often used to relieve pain. Non-narcotic pain relievers (analgesics) such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, tricyclic antidepressants, or muscle relaxants may be useful for some individuals. Regular aerobic exercise, stress management techniques such as yoga, and stretching are most often recommended. Sufficient, regular sleep is also advised.

Source: Medical Disability Advisor



Prognosis

Individuals who take pain relievers as prescribed, follow instructions for exercise, relaxation, massage, hot compresses, and/or sleep as required, and who try to alleviate stressors have an excellent outcome.

Source: Medical Disability Advisor



Complications

Individuals may over-use analgesics containing caffeine, or may develop gastrointestinal (GI) bleeding after prolonged NSAIDs regimens; these individuals are also at 4 times greater risk of developing a seizure disorder (Blanda).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

A quiet work area without fluorescent lighting may be required temporarily. If the individual's job is stressful, mentally or physically, a brief temporary assignment to a less stressful job may be required. Time and place may need to be allotted for rest periods and application of hot compresses, if tension is related to work ergonomic issues.

Risk: Risk is not an issue with the diagnosis of tension headache. Recurrence may be reduced by obtaining regular aerobic exercise, using stress management techniques such as yoga, performing stretching exercises, and getting sufficient, regular sleep.

Capacity: Because tension headache is usually not worsened by physical exertion, capacity is typically not affected.

Tolerance: Tolerance factors depend on the individual's motivation to work despite symptoms of minor head discomfort. No disability is expected.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual complain of a headache that feels like it is "pressing" or "tightening" his or her head? How severe is it? How long has it lasted?
  • Does individual have phonophobia or photophobia, without nausea or vomiting?
  • Does individual have any risk factors such as muscular tightness or dysfunction, stress, lack of sleep, migraine headaches, mood disorders, or anxiety?
  • Does individual have abnormal muscle contractions in the head and neck?
  • Does individual have a lack of reflex in the muscles located near the temples?
  • Does individual have chronic tension headaches?
  • On exam, does individual appear to be in pain? Anxious?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual tried exercise, relaxation, massage of the head and neck, hot compresses to the head, or over-the-counter pain medication to relieve pain?
  • Has individual identified any risk factors?
  • Has individual addressed any correctable risk factors?
  • Has individual been treated with acetaminophen, NSAIDs, tricyclic antidepressants, or muscle relaxants?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Does individual have any complications such as migraine headache or complex headache?

Source: Medical Disability Advisor



References

Cited

Blanda, Michelle. "Headache, Tension." eMedicine. 1 Oct. 2014. Medscape. 14 Jul. 2015 <http://emedicine.medscape.com/article/792384-overview#showall>.

Singh, Manish K. "Muscle Contraction Tension Headache." eMedicine. 29 Aug. 2013. Medscape. 14 Jul. 2015 <http://emedicine.medscape.com/article/1142908-overview#showall>.

Source: Medical Disability Advisor






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