Tension headache — the prevailing form of primary headache. It is shown by tsefalgichesky episodes (several minutes - several days). Pain, as a rule, bilateral, the pressing or squeezing character, moderate or easy intensity, amplifies at usual physical activity. Also phonophobia is sometimes possible photo. Diagnosis of a headache of tension consists mainly in an exception of serious organic violations which can be the cornerstone of a headache: tumors, disorders of brain blood circulation, inflammatory diseases of a brain. Full neurologic examination, EEG, Ekho-EG, REG, according to indications - brain MRT is for this purpose conducted.
Tension headache — the prevailing form of primary headache. It is shown by tsefalgichesky episodes (several minutes - several days). Pain, as a rule, bilateral, the pressing or squeezing character, moderate or easy intensity, amplifies at usual physical activity. Also phonophobia is sometimes possible photo.
Also correspond to the concept "tension headache": GBN, headache of muscular tension, stressful headache, psikhomiogenny headache, psychogenic headache, idiopathic headache.
Classification of a headache of tension
Distinguish several kinds of a headache of tension some of which in turn have subtypes:
- incidental (there are not more often 15 days within 1 month) 1. frequent 2. infrequent
- chronic (there are more than 15 days a month)
Besides, both that and other form of a headache of tension is subdivided into "GBN with tension" and "GBN without tension of perikranialny muscles".
Etiology and pathogenesis of a headache of tension
In modern medicine the headache of tension is considered only as a neurobiological disease. Presumably not only the central, but also peripheral notsitseptivny mechanisms take part in an etiology of a headache of tension. The leading role pathogenesis of a headache of tension is played by hypersensibility of painful structures, and also insufficient function of the descending brake ways of a brain.
The major provocative factor of an attack of headache of tension — an emotional stress. It is proved that switching of attention or positive emotions are capable to reduce intensity of a headache up to its total disappearance. However after a while the headache comes back. One more provocative factor — a so-called muscular factor, i.e. long stay in tension without change of a pose (the compelled position of the head and neck during the work at a table and when driving transport).
There are also factors forming a chronic pattern of pain. One of such factors — a depression. Except the injuring life situations development of a depression is promoted also by features of the personality, these or those her behavioural features. Other factor of synchronization — medicinal (abuse of the symptomatic anesthetizing medicines). It is proved that in case of consumption of a large amount of the anesthetizing medicines the chronic headache of tension is formed twice more often. For treatment of an abuzusny headache it is necessary to cancel the medicine which caused this complication as soon as possible.
Clinical picture of a headache of tension
As a rule, patients describe tension headache as the weak or moderated, not pulsing, bilateral squeezing headache which squeezes the head "hoop". Intensity of such headache does not depend on physical activities, very seldom is followed by nausea. It is shown, as a rule, after a while after awakening and proceeds throughout the day.
Diagnosis of a headache of tension
There are several criteria of diagnosis of a headache of tension:
- Duration of a headache is from 30 minutes up to 7 days 1. existence of at least two of the following signs: 2. intensity of pain does not depend on physical activities; 3. bilateral headache; 4. easy or moderate intensity of pain;
- the nature of pain which is not pulsing, and pressing (squeezing the head "hoop")
- absence of nausea and vomiting
- the headache is not a symptom of other violation of functions of an organism
- increase of pain against the background of strong emotional loadings
- pain relief against the background of positive emotions and psychological relaxation
As except the above-mentioned signs indicating tension headache, patients often complain of feeling of discomfort and even burning in a nape, the back surface of a neck and a forearm (a syndrome of "a hanger for a coat"), at survey of the patient it is necessary to investigate kranialny muscles. It is proved that the most sensitive diagnostic method for detection of dysfunction of perikranialny muscles at patients with GBN is the palpation. This dysfunction comes to light when pressing in the field of frontal, chewing, - clavicular and mastoidal and trapezoid muscles, and also at a palpation rotary motions of the 2nd and 3rd fingers in the same muscles. Existence of dysfunction of perikranialny muscles is considered further at the choice of strategy of treatment. Hypersensitivity of perikranialny muscles during a palpation means existence "chronic (or incidental) tension headache with tension of perikranialny muscles".
Besides, above-mentioned signs are quite often accompanied by manifestations of disturbing and depressive frustration in the form of melancholy, the lowered background of mood, apathy or, on the contrary, the increased aggression and irritability. Extent of such frustration at a headache of tension can vary from easy to heavy.
For an exception of the organic reason for the arising tension headache (to a tumor, inflammatory processes, violations of blood circulation of a brain) conduct a full complex of neurologic examinations: Brain EEG, a rheoencephalography, EHO-EG, at existence of indications - brain KT or MPT.
The main difference of an incidental headache of tension from chronic GBN is the number of days (days / in a month) in which this headache is shown.
Treatment of a headache of tension
In treatment of a headache of tension neurologists apply an integrated approach. First, it is necessary to normalize emotionally a condition of the patient, secondly, to eliminate dysfunction of perikranialny muscles. Besides, it is necessary to take measures for prevention of a medicinal abuzus. Reduction of a pain and musculotonic syndrome, prevention of transformation of an incidental headache of tension in chronic GBN becomes result of such treatment.
As drug treatment of a headache of tension apply the following groups of medicines: antidepressants (selective inhibitors of the return capture of serotonin, selective inhibitors of the return capture of serotonin and noradrenaline); miorelaksant (, ); NPVS (diclofenac, , ketoprofen); medicines for preventive treatment of migraine (in case of tension headache combination to migraine). As non-drug methods of treatment of a headache of tension apply acupuncture, manual therapy, massage, relaxation therapy, biologically feedback.