import json

data = {
 "topic": "Tension Headache",
 "slug": "tension-headache",
 "category_id": 15871,
 "summary": "Tension-type headache is the most common headache disorder in children, a mild-to-moderate, bilateral, nonthrobbing, pressing headache from pericranial muscle tension that is distinguished from migraine mainly by its lack of associated disability and diagnosed using ICHD-3 criteria.",
 "written_by": "claude-sonnet",
 "references": [
  {"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024", "author": None, "pages": [3679, 3689, 3690]},
  {"title": "Pediatric Decision-Making Strategies", "author": "Pomeranz, Albert J.", "pages": [202]},
  {"title": "PPE: Preparticipation Physical Evaluation", "author": "American Academy of Family Physicians, American Academy;American Academy of Pediatrics;American College of Sports Medicine;American Medical Society for Sports Medicine, American Medical;", "pages": [92]},
  {"title": "MedStudy Pediatrics Core 11th Edition 2024-2025", "author": None, "pages": [463, 464]},
  {"title": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga)", "author": "CamScanner", "pages": [582]},
  {"title": "Pediatric ICD-10-CM 2023", "author": "American Academy of Pediatrics Committee on Coding and Nomenclature;", "pages": [214]},
  {"title": "Cover", "author": "Vitalsource Download", "pages": [8539]},
  {"title": "The Harriet Lane Handbook (The Johns Hopkins Hospital)", "author": None, "pages": [653]}
 ],
 "short": [
  {"title": "In short", "content": (
   "- Tension-type headache (TTH) is the most common headache type in children and adolescents; prevalence estimates range widely, up to 48% in some studies, with a lifetime prevalence cited as high as 70% in another source, and about 20% of children have a combination of migraine and TTH\n"
   "- Tension headaches are by far the most common headache overall, more common than migraine; average age of onset is around 7 years\n"
   "- Sex distribution shifts with age: slightly more common in males under 7 years, roughly equal between 7-11 years, and far more common in females during adolescence\n"
   "- ICHD-3 subclassifies TTH as infrequent episodic (<1 day/month, <12 days/year), frequent episodic (1-15 days/month), or chronic (>15 days/month for at least 3 months), with or without pericranial muscle tenderness\n"
   "- Diagnostic criteria for infrequent episodic TTH: at least 10 episodes, lasting 30 minutes to 7 days, with at least 2 of (bilateral location, pressing/tightening nonpulsating quality, mild-moderate intensity, not aggravated by routine physical activity), plus no nausea/vomiting and no more than one of photophobia/phonophobia\n"
   "- Pain is classically described as a constant, dull, pressing/tightening sensation, often like a band around the head, bilateral, most often frontal though also occipital or vertex, and typically worsens as the day progresses (infrequent in the morning)\n"
   "- Unlike migraine, TTH pain is not aggravated by routine physical activity and is not associated with significant nausea, vomiting, or more than one of photophobia/phonophobia\n"
   "- Increased pericranial tenderness on manual palpation is the most significant exam finding, present interictally and increasing with headache intensity/frequency\n"
   "- New daily persistent headache (NDPH) is a distinct entity: abrupt-onset daily headache from within 3 days of onset, bilateral, mild-moderate, with features that can overlap migraine or TTH but no more than one of photophobia/phonophobia/mild nausea\n"
   "- Chronic headache is defined as occurring more than 15 days per month for at least 3 months; medication-overuse headache is a recognized secondary cause when simple analgesics, triptans, ergotamines, or opioids are used too frequently"
  )}
 ],
 "long": [
  {"title": "Definition", "content": (
   "Tension-type headache (TTH) is a primary headache disorder characterized by mild-to-moderate, bilateral, nonthrobbing head pain, classically described as a pressing or tightening sensation, often likened to a band around the head. The International Classification of Headache Disorders, 3rd edition (ICHD-3) subclassifies TTH by frequency into infrequent episodic (fewer than 12 headache days per year, i.e., less than 1 day per month), frequent episodic (1-15 days per month), and chronic (more than 15 days per month, sustained for at least 3 months), and further divides each category by the presence or absence of pericranial muscle tenderness. TTH can be conceptualized as roughly the clinical opposite of migraine: where migraine is typically moderate-to-severe, focal, worsened by or limiting physical activity, and throbbing, TTH is mild-to-moderate, diffuse, not affected by routine activity, and nonthrobbing."
  )},
  {"title": "Epidemiology", "content": (
   "TTH is the most common headache disorder in children and adolescents and is more common overall than migraine. Reported prevalence varies substantially across studies - figures as high as 48% have been reported for TTH, and a lifetime prevalence as high as 70% has also been cited - with roughly 20% of children experiencing a combination of migraine and TTH features. The average age of onset for pediatric headache overall is approximately 7 years. The sex distribution of headache shifts over childhood: headaches occur somewhat more often in males younger than 7 years, occur about equally between males and females from 7 to 11 years, and become far more frequent in females during adolescence."
  )},
  {"title": "Pathophysiology", "content": (
   "TTH is thought to be mediated by sustained contraction of the pericranial muscles attached to the skull, historically the basis for its designation as a \"muscle contraction\" or \"tension\" headache in classic pathophysiologic schemes of headache. Increased pericranial muscle tenderness, elicited by manual palpation, is considered the most significant abnormal examination finding in TTH; this tenderness is typically present between headache episodes (interictally), increases during an actual headache, and correlates with the intensity and frequency of headaches. A related entity, cervicogenic headache, arises from musculoskeletal components of the cervical spine and may be provoked by manipulation of these structures; persistent musculoskeletal pain is thought to cause referred head pain and central sensitization, a mechanism proposed for both cervicogenic headache and primary headache types including TTH. Poor posture and cervical overuse injury are cited contributors to cervicogenic headache specifically."
  )},
  {"title": "Clinical features", "content": (
   "Patients describe a constant, dull, pressing or tightening (nonpulsating) ache, most often bilateral and located frontally, though it may also be felt occipitally or at the vertex, or described as localized to the back of the head and neck. The headache is generally infrequent in the morning and tends to become more severe as the day progresses. By ICHD-3 criteria for infrequent episodic TTH, episodes last 30 minutes to 7 days, and diagnosis requires at least two of: bilateral location, pressing/tightening (nonpulsating) quality, mild-to-moderate intensity, and lack of aggravation by routine physical activity such as walking or climbing stairs. Nausea and vomiting are absent (or, per some sources, are absent to only mild), and no more than one of photophobia or phonophobia may be present - findings that, if more prominent, would favor migraine instead. New daily persistent headache (NDPH) is a distinct headache type characterized by an abrupt onset (occurring daily from within 3 days of onset), typically bilateral and mild-to-moderate, that can share features with either migraine or TTH but, again, no more than one of photophobia, phonophobia, or mild nausea; this diagnosis requires at least 3 months of headache and a clearly described abrupt onset - it should not be applied if the patient cannot describe such an onset."
  )},
  {"title": "Diagnostics", "content": (
   "TTH is a clinical diagnosis based on ICHD-3 criteria and a history that excludes red flags for secondary headache. Examination should specifically assess for pericranial muscle tenderness by manual palpation, the most significant supportive finding. Chronic headache (more than 15 days per month for at least 3 months) and medication-overuse headache (from frequent use of simple analgesics, NSAIDs, triptans, ergotamines, or opioids) should be considered and screened for in any child with frequent or persistent headache, since ongoing overuse of acute headache medications can itself perpetuate a chronic headache pattern."
  )},
  {"title": "Differential diagnosis", "content": (
   "The broad differential for pediatric headache includes vascular causes (febrile illness, migraine, hypertension, hypoxia, caffeine withdrawal), inflammatory/infectious causes (meningitis, encephalitis, brain abscess, pharyngitis, upper respiratory infection, dental or sinus infection, retro-orbital cellulitis), traction/compression causes (brain tumor, intracranial hemorrhage, increased intracranial pressure from cerebral edema, hydrocephalus, or idiopathic intracranial hypertension, post-lumbar-puncture headache, arterial dissection), post-traumatic headache, and psychogenic headache, in addition to muscle-contraction (tension-type) headache. Red flags suggesting a secondary cause rather than TTH include additional neurologic symptoms: a brain tumor typically causes chronic, progressive headache often with nausea, vomiting, ataxia, or visual problems; intracranial hemorrhage (subdural, epidural, or subarachnoid) usually presents with additional neurologic findings such as abnormal eye movements or partial paralysis; carbon monoxide poisoning often presents with flu-like symptoms, fatigue, and altered mental status; and hypertensive encephalopathy, while rare in children, should be considered when blood pressure is elevated. Cervicogenic headache, arising from cervical spine musculoskeletal pathology and provoked by neck manipulation, is a further mimic to consider, particularly with a history of poor posture or cervical overuse."
  )}
 ],
 "clinical": [
  {"title": "Approach at the bedside", "content": (
   "In a child or adolescent presenting with recurrent bilateral, dull, pressing headache that worsens through the day, is not aggravated by routine activity, and lacks significant nausea/vomiting or more than one of photophobia/phonophobia, work through the ICHD-3 frequency classification (infrequent episodic, frequent episodic, or chronic) to characterize the headache and guide counseling and follow-up. Examine specifically for pericranial muscle tenderness on palpation, which supports the diagnosis, and take a careful history for red flags that would point toward a secondary cause instead - progressive course, nausea/vomiting/ataxia/visual changes (concerning for a mass lesion), abnormal eye movements or focal weakness (concerning for hemorrhage), fever or meningeal signs (concerning for CNS infection), or a history of trauma.\n\nAsk specifically about the frequency and type of any headache medications being used, since frequent use of simple analgesics, NSAIDs, triptans, or opioids can itself cause medication-overuse headache and should be addressed as part of management. If the headache began abruptly and has been present daily since within 3 days of onset, consider new daily persistent headache (NDPH) rather than standard TTH, since this distinct entity is defined specifically by that abrupt onset pattern. Document headache frequency systematically at follow-up, since crossing the threshold of more than 15 days per month for 3 months redefines the headache as chronic and may change the management approach."
  )}
 ]
}

with open("/tmp/tension-headache.article.json", "w") as f:
    json.dump(data, f, indent=1)
print("written")