Tension headache is the predominant form of primary headache. It is manifested by cephalgic episodes (several minutes – several days). Pain, as a rule, is bilateral, of a pressing or compressive nature, of moderate or mild intensity, does not increase with normal physical exertion. Sometimes photophobia and phonophobia are possible. The diagnosis of tension headache consists mainly in the exclusion of serious organic disorders that may underlie the headache: tumors, disorders of cerebral circulation, inflammatory diseases of the brain. For this purpose, a complete neurological examination, EEG, Echo-EG, according to indications, an MRI of the brain is performed.
G44.2 Tension type headache
Tension headache is the predominant form of primary headache. It is manifested by cephalgic episodes (several minutes – several days). Pain, as a rule, is bilateral, of a pressing or compressive nature, of moderate or mild intensity, does not increase with normal physical exertion. Sometimes photophobia and phonophobia are possible. The concept of “tension headache” also corresponds to: TH, muscle tension headache, stress headache, psychomyogenic headache, idiopathic headache.
There are several types of tension headache, some of which in turn have subtypes:
- episodic (occurs no more than 15 days within 1 month) 1. frequent 2. infrequent
- chronic (occurs more than 15 days a month)
In addition, both forms of tension headache are divided into “TH with tension” and “TH without tension of pericranial muscles”.
In modern medicine, tension headache is considered exclusively as a neurobiological disease. Presumably, not only central, but also peripheral nociceptive mechanisms are involved in the etiology of tension headache. The leading role in the pathogenesis of tension headache is played by increased sensitivity of pain structures, as well as insufficient function of the descending inhibitory pathways of the brain.
The main provoking factor of an attack of tension headache is emotional stress. It has been proven that switching attention or positive emotions can reduce the intensity of headache until its complete disappearance. However, after a while the headache returns. Another provoking factor is the so—called muscle factor, i.e. a prolonged stay in tension without changing the posture (forced position of the head and neck when working at the table and when driving vehicles).
There are also factors that form a chronic pain pattern. One of these factors is depression. In addition to traumatic life situations, the development of depression is also promoted by personality traits, certain behavioral features. Another factor of chronization is drug abuse (abuse of symptomatic painkillers). It is proved that in the case of consuming a large amount of painkillers, chronic tension headache is formed twice as often. To treat an abusive headache, it is necessary to cancel the drug that caused this complication as soon as possible.
As a rule, patients describe tension headache as mild or moderate, non-pulsating, bilateral compressive headache that compresses the head with a “hoop”. The intensity of such a headache does not depend on physical exertion, it is very rarely accompanied by nausea. It usually manifests itself some time after waking up and continues throughout the day.
There are several criteria for diagnosing tension headaches:
- Duration of headache from 30 minutes to 7 days 1. presence of at least two of the following signs: 2. pain intensity does not depend on physical exertion; 3. bilateral headache; 4. mild or moderate pain intensity;
- the nature of the pain is not pulsating, but pressing (squeezing the head with a “hoop”)
- the absence of nausea and vomiting
- headache is not a symptom of another violation of the body’s functions
- the increase in pain against the background of strong emotional loads
pain relief on the background of positive emotions and psychological relaxation
Since, in addition to the above signs indicating tension headache, patients often complain of a feeling of discomfort and even burning in the back of the head, back of the neck and forearm (coat hanger syndrome), it is necessary to examine the cranial muscles when examining the patient. It has been proven that palpation is the most sensitive diagnostic method for detecting pericranial muscle dysfunction in patients with TH. This dysfunction is detected by pressing in the frontal, masticatory, sternocleidomastoid and trapezius muscles, as well as by palpation with rotational movements of the 2nd and 3rd fingers in the area of the same muscles. The presence of pericranial muscle dysfunction is taken into account in the future when choosing a treatment strategy. Hypersensitivity of the pericranial muscles during palpation means the presence of “chronic (or episodic) tension headache with tension of the pericranial muscles.”
In addition, the above signs are often accompanied by manifestations of anxiety and depressive disorders in the form of melancholy, reduced mood background, apathy or, conversely, increased aggressiveness and irritability. The degree of such disorders in tension headaches can vary from mild to severe.
To exclude the organic cause of the tension headache (tumors, inflammatory processes, circulatory disorders of the brain), a full range of neurological examinations is carried out: brain EEG, rheoencephalography, ECHO-EG, if there are indications – CT or MRI of the brain.
The main difference between episodic tension headache and chronic TH is the number of days (days / month) in which this headache manifests itself.
In the treatment of tension headaches, neurologists use an integrated approach. Firstly, it is necessary to normalize the emotional state of the patient, and secondly, to eliminate the dysfunction of the pericranial muscles. In addition, it is necessary to take measures to prevent drug abuse. The result of such treatment is a reduction in pain and muscle-tonic syndrome, preventing the transformation of episodic tension headache into chronic TH.
The following groups of drugs and procedures are used as medication for tension headache:
- antidepressants (selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors);
- muscle relaxants (tolperizone, tizanidine);
- NSAIDs (diclofenac, naproxen, ketoprofen);
- medications for the preventive treatment of migraine (in case of a combination of tension headache with migraine);
- occipital nerve blockages.
Acupuncture, manual therapy, massage, relaxation therapy, and biofeedback are used as non-drug methods of treating tension headaches.