Tension headache: symptoms and treatment

Tension headache (HDN) is one of the most common types of headache in the world. Despite the fact that such a wording is not quite familiar to most people, nevertheless, the prevalence of this disease is very high. According to statistics, up to 70% of the world's population in life experience this diagnosis to some extent. So what is this - a tension headache? What is it manifested, what are its symptoms? How is it treated? Let's find out more.

In the International Classification of Diseases, a tension headache is an independent diagnosis. Synonyms are such formulations as headache of muscle tension, psychomyogenic headache, stress headache, psychogenic headache, idiopathic headache.

By definition, HDN is a bilateral, diffuse headache with a compressive (compressive) character of mild or moderate intensity. It refers to primary headaches, that is, to situations where there are no indications for other diseases that could cause such symptoms. The patient may have other diseases of the body, but there is no connection between GBN and the disease (for example, 6 months back patient suffered a concussion of the brain, and now he has GBN, and both events are not related to each other friend).

Symptoms

With a tension headache, patients complain of aching, dull, monotonous, squeezing, constricting pain. Sometimes even the word "pain" is not used, patients describe their feelings as discomfort, "helmet "helmet "hat "cap "hoop" on the head, which you really want, but it is impossible to remove. More often the pain captures both halves of the head, but it can be one-sided.

HDN can appear in certain areas (frontal, parietal, occipital), can migrate from one part of the head to another, start at a single point and "spill over" the entire head. Pain can be localized only in the head region, but often extends to the neck and shoulder girdle.

Sensations can be amplified by touching the head, dressing the headdress, combing, even blowing a breeze.

Usually, the symptoms of a tension headache disturb the patient during the daytime and very rarely occur in the night.

The criteria of the tension headache are developed:

• bilateral character;
• pain compressive (squeezing, tightening);
• severity of pain from mild to moderate;
• the headache does not increase from the usual physical exertion (for example, down the stairs, walking to work on foot).

In order to diagnose the tension headache was exposed, it is necessary that at least two of the above characteristics are present.

In addition, it is believed that the tension headache is never accompanied by nausea or vomiting. If such symptoms appear, this is another kind of headache. The headache of tension can be accompanied by a decrease in appetite. It is possible to increase pain from bright light or loud sound, which is why such patients have light and noise.

What does the wording "light or moderate pain" mean? The degree of pain is assessed using different scales. In particular, it is quite common to use a visual analogue scale of pain (when the entire range of pain is located on a line 10 cm long. The beginning of the line corresponds to the absence of pain, and the end to the maximum possible, in the patient's opinion, to the sensation of pain). The patient is offered to mark on the line a place corresponding to the force of pain. With a tension headache, this is usually not more than 50% of the entire line (5 cm).

Depending on the duration of pain, the following types of GBN are distinguished:

• episodic;
• chronic.

Episodic tension headache is characterized by such signs:

• presence of at least 10 episodes of characteristic headache (corresponding to the criteria of HDN);
• duration of an attack of a headache from 30 minutes. The number of days with such attacks is up to 15 per month (up to 180 per year).

That is, if you have had attacks of moderate compressive bilateral headache that lasted 1 hour and not 10 times in the last two months increased from usual physical activity, and thus you experienced discomfort from bright light, it means that you have a headache voltage.

Episodic HDN may be infrequent (no more than 12 days per year) and frequent (from 12 to 180 days per year).

Chronic tension headache is associated with such characteristics:

• Attacks of GBN occur more often 15 days per month (more than 180 days per year);
• the total duration of the disease is at least 3 months.

Usually, the severity of pain in chronic HDN is stronger than with episodic HDN. Chronic HDN occurs if you do not treat episodic HDN.

HDN can be combined with the tension of the pericranial muscles or muscles of the neck. The pericranial muscles include frontal, temporal, chewing, pterygoid, trapezoidal, sternocleidomastoid, occipital muscles. Muscle tension is clinically manifested by soreness during palpation (or pressure pressing with a special pressor algometer device). Perhaps the existence of HDN without muscle tension, this pain is more easily tolerated.

Who has a tension headache?

What's wrong with this headache, that she was even identified as a separate disease? An easy or moderate headache... a few times a month... But who did not feel this? The fact of the matter is that most of the young people (mostly people 30-40 years old) suffer from this diagnosis, and more often they are mental workers. The higher the social and educational level of a person, the more he is at risk of developing a tension headache. Most of the time, the professional activity of mental workers is associated with emotional tension, concentration, attention fixing. And all this in a "sedentary" way of life. Emerging symptoms do not allow such people to work qualitatively, the productivity of labor falls, and the health deteriorates. Some resort to independent treatment, which is not always correct, which aggravate the situation, provoking the transition of episodic HDN into chronic.

The headache of stress causes a loss of ability to work of a huge number of people. In the United States, it was estimated that in connection with GBN, annual budget losses amount to $ 10 billion, and in Europe $ 15 billion. Not a little, is not it?

What triggers the onset of pain?

There are no clear causes of tension headache, but the factors that cause it are identified:

• mental overstrain;
• violation of the ratio of pain and pain systems of the body.

Mental overstrain (chronic stress) leads to the development of muscle spasm, which is accompanied by muscle tension. The vessels located in the thickness of the muscle tissue undergo compression. Muscle nutrition deteriorates, at the biochemical level, the metabolic rate changes. There is a painful feeling. Pain is a signal to the body about the need to change something (in particular, to remove stress), so that Even more severe changes, since the tension headache alone does not pose a threat to the life. But long-term stress can cause much more dangerous neurological diseases.

Violation of the ratio of pain and analgesic systems occurs when the autonomic nervous system is involved. Anxiety, emotional stress, depression lead to an imbalance of substances serving as "carriers" of information in the nervous system - mediators. The level of serotonin decreases, which is a powerful analgesic substance. Each person has pain receptors that have a certain threshold of excitation, above which pain is felt. With an imbalance of mediators, the threshold of excitation of pain receptors decreases - the pain arises from minor effects (for example, touching, combing).

With a headache of tension, all these processes are interrelated, and a clear connection with stress is always traced. Often, GBN accompanies neuroses, asthenic and hypochondriac syndromes.

Diagnostics

To find out the cause of the headache, the doctor analyzes the complaints and examines the patient.

To express the diagnosis of headache, the stresses are described in the clinical characteristics described above. Find out the nature, duration of pain, duration of life. Sometimes the patient is advised to keep a diary of pain, where it is necessary to record all episodes of the onset of pain and their characteristics. The doctor then evaluates these records.

The soreness of the pericranial muscles is determined by palpation: they make small rotational movements with the second-third fingers of the hand. More reliable information is obtained when using a pressor algometer (which is not available in every medical institution).

It is important to determine if the tension headache is a symptom of another disease. For this, additional diagnostic methods are used: X-ray of the cervical spine and skull with functional tests, CT (computed tomography) or MRI (magnetic resonance imaging), REG (rheoencephalography), UZDG (ultrasound examination of blood vessels head).

Treatment

Approaches to the treatment of episodic and chronic tension headaches vary.

Treatment of episodic HDN

Episodic tension headache does not lead to a sharp decline in vital activity. It requires periodic use of medicines. For this purpose, the following are used:

• with infrequent episodic HDN - non-steroidal anti-inflammatory drugs: Ibuprofen (Imeth, Nurofen, Brufen) 400 mg once, Ketoprofen (Ketonal, Flamax) 25-50 mg, Lornoxicam (Ksefokam) 4-8 mg, Meloxicam (Melbeck, Movalis), -15 mg, Naproxen (Nalgezin) to 250-500 mg. It is advisable to apply the drugs no more than 5-10 times a month, so as not to cause an abusus headache (pain as a result of abuse of anesthetic medication);
• with frequent episodic HDN, a course of non-steroidal anti-inflammatory drugs as an attempt to break the cycle of repetitions (for example, Ibuprofen 400 mg 2-3 times a day for 3 weeks). If a single course application does not lead to the disappearance of a headache, then trying to repeat the course is useless;
• if HDN is accompanied by muscular tension, then muscle relaxants are shown: Tolperisone (Midokalm) to 150 mg once, Tizanidine (Sirdalud, Tizalud) 2-4 mg once in combination with the administration of 500 mg Aspirin. With frequent episodic HDN, muscle relaxants are prescribed a course of 2-4 weeks (Meadocalm 150-450 mg / day, Sirdalud 4 mg / day).

As additional agents for episodic tension headache, B group vitamins (Neurorubin, Milgamma, Neurovitan), nootropic drugs (Noofen, Fenibut, Glycine), sedatives (to regulate the processes of autonomic dysfunction and to remove anxiety).

From non-drug treatments for episodic headache, stress is used:

• psychotherapy (training in psycho-relaxation, auto-training);
• massage;
• Physiotherapy (electrosleep, electrophoresis);
• acupuncture.

Separately, we should speak about such a method as the method of biological feedback using computer technology. In this case, in the case of HDN, a person is provided with information on the state of tension of the pericranial muscles in the form of a sound signal. The signal varies depending on the degree of muscle tension. A person concentrates on his inner sensations, compares them with sound, and then seeks to regulate and control this process. As a result, a person can learn to change to a certain degree the muscle tone, relieve tension and thus eliminate pain.

Treatment of chronic HDN

The diagnosis of "chronic tension headache" is a contraindication to taking painkillers! They in this case are ineffective and complicate the already complex task of coping pain.

All over the world, antidepressants are used to treat chronic HDN:

• tricyclic antidepressants (amitriptyline) - prescribed for a long time for 2-6 months. Begin reception with ¼-1/2 tablets, increasing the dose twice every 3 days, and bring it to 75 mg. So take a few months, and then consistently reduce the dose until complete withdrawal;
• selective serotonin reuptake inhibitors, norepinephrine - Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Serlift, Zoloft). They are very effective in fighting chronic tension headaches and at the same time have significantly fewer side effects than tricyclic antidepressants.
• Other antidepressants - Mianserin (Lerivon) 15 mg twice a day, Tianeptin (Coaxil) 1, mg 3 times a day.

Treatment with antidepressants is at least 2 months. At the same time, not only the analgesic effect is achieved, but also psycho-vegetative activity is normalized, that is, the level of anxiety, fear, emotional tension is reduced, and the mood is normalized. Thus, it affects not only the pain itself, but also its causes.

Non-drug treatment methods must necessarily be present in a complex of measures to eliminate pain in chronic HDN. The same methods are used as with episodic tension headache.

It is not always possible to help a patient with the first course of treatment. Sometimes only repeated and prolonged pharmacological and non-pharmacological actions help to get rid of the disease. And this requires patience from both the doctor and the patient.

The headache of tension is a frequent problem of modern man. Chronic stress does not pass by each of us, and the tension headache is one of its many consequences. The disease is not dangerous to humans, but it can make itself felt quite often and lead to a significant limitation of life. Treatment of the disease requires a thoughtful and patient approach. For this, both medicamentous and non-medicament methods are used.

4th channel, the program "Express Health" on the topic "Headaches of tension"

VitapowerTV, broadcast on the topic "Headache of tension