What is the most appropriate course of action for a 33-year-old man with episodic tension-type headaches and a normal neurological exam?

For a 33-year-old man experiencing episodic tension-type headaches who has a normal neurological exam, the most appropriate course of action is to forgo any diagnostic studies. Tension-type headaches are the most common type of primary headache, characterized by mild to moderate intensity, a band-like pressure or tightness around the head, and they generally do not interfere with daily activities.

In cases where the neurological examination is normal and the patient’s headache pattern is consistent with tension-type headaches, additional imaging or diagnostic studies are unnecessary. The diagnosis of tension-type headache primarily relies on the clinical history and presentation rather than imaging. This approach helps to avoid unnecessary exposure to radiation or contrast agents and reduces healthcare costs.

While imaging studies like CT or MRI may be indicated in cases where a secondary headache cause is suspected (e.g., sudden onset, changes in pattern, or accompanying neurological deficits), this is not relevant for a patient with a typical presentation of tension-type headaches. Therefore, no diagnostic study is necessary in this scenario, and management can focus on symptomatic relief and lifestyle modifications.