Tension headache( HDN) - Causes, symptoms and treatment. MF.

Tension headache( HDN) is the most common headache.

Monotonous, compressive, compressive, tightening, blunt, diffuse, two-sided, "wrapped in a hoop", "as in a helmet", "in a vice", mild to moderate, accompanied by irritability, nervousness, fatigue, weakness, fatigue, sleep disturbanceand appetite, increased sensitivity to sharp sounds and bright lighting - these are all the "compliments" about her - the tension headache. Tension headaches are subject to all age categories of the population, even children, women suffer somewhat more often.

Causes of tension headache

HDN develops during mental overstrain, as a result of chronic stress and as a result of prolonged muscle strain. Muscle tension is more often associated with a professional posture - a long sitting at the computer, driving a car, work associated with prolonged visual stress, for example, with small details( seamstresses, watchmakers, jewelers, electronic equipment collectors. ..), constant monitoring of video monitors. An uncomfortable posture during sleep can also be a cause of tension headache. In the mechanism of development of HDN, the tension of the muscles of the neck, eye muscles, and scalp aponeurosis muscles - the so-called "muscle stress" - is important.

Long-term use of analgesics and tranquilizers contributes to the development of chronic headache. In real life, all these factors are often combined.

Headache intensification can be triggered by emotional stress, weather change, strong wind, starvation, work in a stuffy room, mental and physical overwork, night work, incorrect posture while sitting, drinking alcohol.

In the pathogenesis of tension headaches, the role plays:

- tonic muscle spasm, as a trigger for ischemia, edema, electrolyte and biochemical changes leading to vasospasm and pain,
- disorders in the central mechanism of chronic pain - reduction in pain threshold, insufficiency of serotonergicsystems, insufficiency of the function of the antinociceptive system,
- depression.

"Pain behavior" - the behavioral reactions of the patient to chronic pain - disrupt the processes of adaptation of the body and aggravate the pain syndrome. There are neurons with increased excitability and an insufficient inhibitory mechanism in the structures of the brain in which nociceptive( painful) information is processed( frontal and temporal lobes, their mediobasal part and limbic system).

In the development of chronic tension headache, the functioning of the antinociceptive system and psychosocial disadaptation as a consequence of behavioral, personal, emotional reactions of the organism at the level of neurotransmitter mechanisms are of importance.

The antinociceptive system is a neuroendocrine analgesic mechanism. When the pain threshold is lowered, the usual stimuli of the receptors are perceived as painful. Perhaps the perception of pain without pathological impulses from perceiving receptors, but due to the emergence of foci of excited neurons - "amplified pathological excitation generators" in the brain. Dysfunction of the antinociceptive system is expressed in decreasing descending inhibitory effect on neurons that perceive and conduct nociceptive sensory flows. Thus, both the perception of pain and its conduct are disturbed, the treatment and response to it are its inhibition.

The main mediators of the analgesic system:

- opiate-like neuropeptides - enkephalins and endorphins have a chemical similarity with narcotic analgesics,

- biogenic amines produced by serotoninergic and noradrenergic neurons - affect the perception of pain like tricyclic antidepressants.

It turns out that the body itself produces painkillers. With pathology, this mechanism is broken or not working enough. With emotional stress, overwork, psychopathological conditions, pain control is reduced at all levels of pain impulse treatment. Weak signals from strained muscles are perceived inadequately painful. The appearance of hyperactive neurons leads to the development of chronic pain. Depression exacerbates these disorders at the level of neurotransmitter biochemical processes and supports pain syndrome.

Symptoms of tension headache

Distinguish tension headache with dysfunction of the pericranial musculature and without such a combination.

Depending on the duration and periodicity of the headache, classified - episodic and chronic forms of tension headaches.
Headache lasting from 30 minutes to 7 days for two weeks a month and 6 months a year is an episodic headache. It is more often observed - up to 80% of all types of headache.
Headache that lasts longer than 2 weeks for a month and longer than six months throughout the year is a chronic headache.

Episodic headache is usually less intense, often accompanied by anxiety disorders, occurs after provoking moments - prolonged visual or mental stress, uncomfortable posture. Chronic headache - almost daily, not stopping, monotonous, does not change from the loads, intensive, accompanied by the development of depression, demonstrative, paranoiac personal changes, a violation of social activity.

Tension headache is not accompanied by nausea and vomiting, has no seizures, is not of a pulsating nature.

If you have a headache, you need to see a doctor - a family doctor, a therapist, a neurologist.

Obsession with a tension headache

The examination reveals an increased tension and soreness of the trapezius muscle, neck muscles, paravertebral points of the cervical and thoracic spine, and there is no focal neurological symptomatology. If the tension headache is not accompanied by painful pericranial muscles, then it is considered to be psychogenic. Quite often the tension headache is accompanied by psychopathological disorders - anxious-depressive, premenstrual tension, asthenic, psycho-vegetative disorders - fluctuations in blood pressure, tachycardia, lack of air, panic attacks.

Primary comprehensive examination is necessary to exclude organic brain damage. Computer and magnetic resonance imaging, radiography or tomography of the cervical spine, electroencephalography( with syncope), dopplerography of the main arteries, examinations of the oculist, the therapist, the otolaryngologist, laboratory diagnostics - a general blood test, blood sugar, biochemical analyzes( here individually independing on the detected somatic abnormalities).The results of psychological testing contribute to an adequate selection of therapy in a particular patient.

Differential diagnosis:

- headache diagnosis,
- organic neurological diseases,
- somatic diseases, in which a headache is one of the symptoms.

Treatment of tension headache

Treatment of tension headache is directed to psychohalgic, myofascial and cervicogenic factors. Used in the treatment of pharmacological and non-medicinal methods of exposure.

For relief of headache, it is recommended to use head and neck massage of the collar zone, post-isometric relaxation, acupressure, acupuncture, and short reception of analgesics. Good results in the treatment of chronic headaches give cognitive-behavioral therapy.

Massage with tension headache

Self-massage

More often with a headache, use paracetamol, non-steroidal anti-inflammatory drugs( ibuprofen) and their combined drugs with codeine, phenobarbital, caffeine, possibly in combination with tranquilizers. It is important to remember that long-term use of analgesics and tranquilizers will lead to an abusus headache.

Prevention of headache

For the prevention of headaches recommend optimizing the regime of the day, working and rest conditions, physical therapy, water procedures, individual recommendations of the vertebronevrologist, neurologist and therapist, physiotherapy, psychotherapy, aromatherapy, manual therapy, spa treatment. From pharmacological drugs are used muscle relaxants( sirdalud, midocals) and antidepressants. Treatment is selected individually! Antidepressants are prescribed by the doctor due to possible side effects and the need for long-term use - at least 6 months with a gradual increase and subsequent dose reduction.

The analgesic effect of antidepressants is that, firstly, the effect is achieved through the weakening of depression;secondly, they enhance the action of both exogenous and endogenous analgesic substances;Thirdly, antidepressants activate descending antinociceptive systems. Even the analgesic effect occurs at lower doses, and faster than antidepressant.

At an asthenization apply nootropics, vitamins of group B, preparations of magnesium.

Correct posture when sitting .

Doctor's consultation on the topic of tension headache:

Question of : what is an abusural headache?
Answer : with prolonged or frequent use of analgesics, tranquilizers( up to 15 days per month for 3 months), addiction develops, and pain medications themselves cause a headache. It is called abusus. Therefore, it is impossible to take painkillers frequently and for a long time without control."To abuse" is abuse.

Doctor neurologist Kobzeva S.V.