How to recognize the symptoms and treat tension headaches

Statistics is the most amazing of all Sciences: it enables us to make important conclusions where there are no explicit prerequisites. Did you know for example that every third patient who comes for help to a neurologist, she asks him about the headaches? What kind of headache (GB) occurs most frequently? Statistics say that this is tension headache (TTH).

The Prevalence of TTH in modern society is striking in its scope: according to some reports, incidence it reaches 65% among men and 86% among the female population.

In Addition to gender variability, there is a close relationship between occupation and frequency of tension: people of brainwork more predisposed to its occurrence in comparison with practicing physical labor, as well as unoccupied with no activities.

International

It is Known that physicians use the international classification of diseases, currently the last tenth revision – ICD-10. But the headaches were so urgent problem that they decided to classify separately. All more or less well-known varieties of GPS is reflected in the International classification of headaches, which passed the second review and in the literature indicated MKGB-2.

Despite the widespread prevalence, universal, "academic" definition of TTH does not exist. For definitions of usually use clinical and anamnestic criteria and the existence of GB. Thus, TTH is characterized by the following attributes:

• headache, which arose in response to mental, emotional stress (ie link with acute or chronic stress response);
• muscle tension surrounding the skull (scalp, pericranial muscles – the frontal, occipital or temporal), defined by palpation;
• of the diffuse, widespread diffuse pain, without clear localization, always bilateral;
• pain average strength, tightening or squeezing the skull, very often, to describe tension-type headache use the word "Hoop" or "helmet";
• there is no relationship between pain intensity and daily physical activity, but positive emotions experienced by a patient, significantly reduce the severity of GB;
• non-permanent but fairly typical symptoms are light, phonophobia GB on peak, sometimes accompanied by nausea.

The Duration and frequency of episodes of cephalgia (the medical term for headache) is the basis of modern separation tension-type headache into two groups – chronic and episodic. Besides the difference in terms of the existence of attacks of GB, it is believed that these two clinical forms have also different mechanisms of origin, and accordingly forecasts and treatment campaigns.

Pathogenesis

Tension refers to the primary cephalalgias, that is, in its essence it is an independent disease of the nervous system. At one time the occurrence of tension-type headache explained solely by muscle tension in the scalp due to the detention of a person in the non-physiological position. This theory has a long existence and practical confirmation.

Really, people, completely devoting himself to the computer, truck drivers cephalalgia voltage is very common, and one of the synonyms tension-type headache – headache muscular tension reflects exactly this view of the pathogenesis of the disease. The reasons for running GB – stress, negative emotions. In addition to those traditionally known triggers that provoke GB (especially episodic variant of its flow) can:

• meteorological factors: changes in atmospheric pressure, humidity, wind speed. Incidentally, these triggers are easy to trace in the formation of hypertensive crises. The most likely mechanism of the effect of weather conditions on overall health – reducing the pressure of oxygen in atmospheric air occurring because of the decrease in atmospheric pressure or due to high humidity
• factors, actively participated in the adaptation processes of the body: sleep deprivation, starvation (and associated hypoglycemia), alcohol use. Regarding the latter, more common in tension-type headache episodic drinking alcoholic beverages in humans, non alcoholism, and much less frequently – with regular intake of alcohol.

Irrespective of the underlying cause, the development of tension-type headache attack usually occurs in the following scenario. Acting factorcauses increased tone pericranial muscles and the muscles of the nape, trapezius and other muscles of the shoulder girdle. Itself muscle spasm is perceived by the person as unpleasant sensation of pain mild or moderate in intensity.

repeated episodes of difficult muscle relaxation. The result is a mechanical clamping taking place in their thicker blood vessels, accompanied by violation of inflow and outflow (arterial and venous ischemia). Pain component increases.

In addition, the muscles of the neck, in which there is a strong spastic contraction, changing the relative positions of the cervical vertebrae and break venous outflow from the veins of the cervical plexus, and blood circulation in vertebroplasty-basilar pool (it is known that the vertebral arteries pass through transverse processes of cervical vertebrae).

The deterioration of the cerebral circulation will be of a systemic character already. Especially fast circulatory decompensation and progression of tension-type headache is observed in patients with "weak points" of the neck or head: osteophytes, abnormal mobility of the cervical spine, protrusion of disks.

recently there have been reports, in TTH the light of which looks like the disease is not only peripheral but also a Central component. In advanced cases, when the current long-term tension-type headache, found changes in the Central nervous system. In particular, in the posterior horns of the cervical spinal cord and in the localization of the nuclei of the trigeminal nerve found plastic changes of neurons.

Chronic pain in this scenario is due to structural rebuilding of nerve cells, and TTH can't be fixed just by adjusting lifestyle or avoidance of the effects of certain factors: the neurons themselves produce abnormal pulses and evoke the feeling of a headache. By the way, this very fact was the reason of its use for the treatment of TTH psychotropic drugs: antiepileptic drugs, antidepressants.

peculiarities of diagnostics TTH

According to modern concepts, the diagnosis of primary GB is based almost entirely on clinical and anamnestic data. Recently, some clinicians have expressed doubt that TTH is solely the primary disease. The fact is that sometimes a thorough examination can detect a number of morphological changes, which if not the main reason for the development of GB, considerably facilitate the diagnosis of its occurrence. We are talking about cervical osteochondrosis, hernia of intervertebral disk, vascular anomalies, and many other acquired or congenital diseases. For this reason the diagnosis of any variety of primary headaches should be installed only after exclusion of organic causes of its Genesis.

Treatment of tension-type headache usually involved the physician-neurologist: his professional competence allows you to perform a comprehensive examination and differential diagnosis of the patient. As possible candidates the attending physician may be considered also a practitioner. It is local therapists take their first strike, reflecting the "attack" of the population, complaining of a headache.

When identifying same disposable organic causes related to cervical spine to the treatment connects the doctor of manual therapy, physiotherapist, or reflexologist, in many cases non-pharmacological treatment may get rid of the GB and to remove the pain episode much better pharmacotherapy.

Most Often necessary to differentiate tension-type headache with a migraine (code G43 ICD) and abosutely GB (code ICD 44.4 G). Clinical distinction of these forms of GB are shown in the table.

To get rid of TTH can only be in the early stages of its development, especially when there are disposable causes. In advanced stages the pain (frequent episodic GB, or chronic TTH) treatment can only alleviate the condition of the patient, but to completely rid him of the disease the doctor is not always possible. It should be borne in mind the so-called danger signals in patients with complaints of any chronic GB. These signals is a sign of disaster in the brain, requiring immediate hospitalization and examination. These signals, in particular, include:

• the unexpected emergence of a very strong GB is the type of "lightning strike";
• the occurrence of atypical aura (lasting more than hours or the appearance of weakness in upper/lower limbs)
• the emergence of the aura in a patient without migraine
• new-onset aura against the use of estrogen
• GB, who first appeared in the patient over 50 years old.
• continuously amplifying for several months or weeks GB;
• GB, first manifested on the background of congenital or acquired immunodeficiency (HIV-infection;
• GB, proceeding with disorders of consciousness (stunning, agitation, lack thereof), or a sudden loss of memory;
• GB, accompanied by the emergence of focal neurological symptoms;
• GB amid signs of current active infectious disease (hyperthermia, intoxication).

Treatment

The Treatment of TTH is determined by the form of the disease, of which there are three clinicians: rare episodic, frequent episodic and chronic TTH. The main approaches to the therapy of these States are summarized in the table.

To get Rid of GB, which arose under the influence of precipitating factors, help fast-acting NSAIDs. Today it is established that none of the analgesics can not remove GB all without exception, and each patient required individual selection of the drug.

However, initial treatment is usually recommended acetylsalicylic acid, ibuprofen and paracetamol, lornoxicam, Ketorolac, and naproxen and diclofenac.

To help Relieve the pain and a combination of drugs – tsitramon, askofen, Pentalgin, as well as new drug dipmeter. Combined preformed shape is able to relieve the patient from suffering for a relatively short period of time.

Muscle relaxants a group of drugs prescribed to eliminate pain and excessive tension of muscles of the skull in TTH. Drugs do not have immediate effect but in the exchange application is able to significantly improve the patient's condition. Representatives of this group – tizanidine and baclofen.

To remove the anxiety caused by the ever-present GB, used antidepressants, such as ESCITALOPRAM, sertraline, fluvoxamine and others.

Apart is amitriptyline: it not only helps relieve depression, but also has a specific Central action on the spinal cord neurons. Amitriptyline is actually a drug that is recommended by many international communities to treat a variety of chronic pain.

Anticonvulsant (topiramate, gabapentin, pregabalin) are prescribed to reduce the pathological activity of plastically modified neurons in the spinal cord and the medulla oblongata. Headache muscle tension, which runs continuously, is the main indication for their purpose. Unfortunately, long term administration of these drugs by itself has a negative impact on the patient's condition, causing specific physical and mental side effects.

Tension Headache, the symptoms of which are associated with changes in the cervical region of the spinal column, is a direct indication for manual therapy, massage or acupuncture. To non-pharmacological methods include relaxation and behavioral therapy which helps to relieve spasms and muscle tension.

The Main danger of irrational therapy of tension-type headache – the possibility of abuzeineh GB. To get rid of the tiring cephalgia, patients often take massive doses of drugs and thereby gain a new kind GB.

It is Particularly dangerous in terms of the formation of abuses the use of combined preparations containing NSAIDs, codeine and derivativesbarbiturates. So the first rule of preventing chronic TTH is adequate medical follow-up and individual selection of therapy.

Sources:

1. Neurology. National leadership. M: 2012.
2. Prikhodko, V. Y. Headache in the practice of a General practitioner and family doctor. Ukrainian the medical chasopys, 3 (95) – V /VI 2013. – c. 50-57
3. Headache in General practice. Y. E. Azimova, V. V. Osipov. The magazine “doctor”, 05/14