B. Headache lasting from 30 minutes to 7 days. Bilateral location 4. It is therefore common for physicians in all specialties to be confronted with the patient who complains of pain and tightness over the eyes and in the back of the head and neck. These sensations are variously described as vise-like, pressure, a constricting band, drawing, and aching. Tenderness throughout the trapezius muscles is commonly associated with the above complaints and is most intense along the top of the shoulders and in the upper neck.
Many patients also describe pain, pressure, or paresthesia over the vertex of the head.
Pain can often be elicited by palpation of the trapezius muscles. Brief head pain was induced by intravenous injection of histamine. Contraction of the head and neck muscles was observed in association with the pain, but no pain arose from the muscles themselves, probably because of the short duration of the induced head pain. With respect to the eyes themselves, an irritant introduced into the conjunctival sac sometimes caused, reflexly, contraction of the head and neck muscles and resulted in secondary pain and paresthesia in the head and neck. Abnormally sustained contraction of the ocular muscles produced by placing a 3-diopter vertical prism in front of the dominant eye caused a sustained contraction in the neck muscles, followed by pain in the neck and shoulder.