Tension Type Headache
Headache is one of the leading health problems throughout human history. It affects people very often in every society and every age. It is so difficult to find a person who has never had a headache during his life. The presence of pain-sensitive structures in the head and its surrounding area may explain this situation in part. The compression and displacement of these structures, inflammatory pathologies, continuous contractions of the head and neck muscles, changes in the diameter of intracranial and extracranial arteries, and irritation of pain-sensitive nerves can be the cause of pain. As can be seen from all this information, headaches can have many causes. It can be a life-threatening cause or a way of expressing a situation that does not go well in life.
Headaches published by International Headache Society (IHS) in 1988 and finally in 2004, classified the headaches into two main groups and then classified them into 13 separate groups.
Primary headaches; they are headaches that are not associated with diseases of the central nervous system or other systems. Primary headache accounts for approximately 90% of headache patients.
A. PRIMARY HEADS
Migraine
Tension type headache
Cluster headache and other trigeminal autonomic headaches
Other primary headaches
Secondary headaches; headaches associated with diseases involving the nervous system or other systems. There is no specific type of secondary headache, they can mimic any primary headache.
In secondary headaches;
There is evidence for a demonstrable cause that has emerged in a recent relationship,
Headache is greatly reduced or resolved within 3 months (which may be shorter in some diseases) after successful treatment or spontaneous resolution of the underlying disorder. Despite successful or unsuccessful treatment in progressive events such as brain tumor, it may not disappear within 3 months.
B. SECONDARY HEADACHES
Headaches due to head and / or neck trauma
Headache due to cranial or cervical vascular disorders
Headache attributed to non-vascular intracranial disorders
Headache due to substance (use) or discontinuation
Headache associated with infection (nervous system or systemic)
Headache due to homeostasis disorder
Headache or facial pain linked to cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other face or cranial structures
Headache due to psychiatric disorders
Cranial neuralgias and causes of central facial pain
Features suggestive of secondary headache in the story:
Onset of headache before the age of 10, after the age of 50
It has started in the last 6 months, or in terms of character, frequency and violence.
change
Progressive and non-responsive within days
Acute and severe features of new onset headache
Defining the person as the şiddetli most severe pain yaşam in his life
Occurrence during pregnancy or after childbirth
Increased physical activity by straining or coughing
Associated with body and head position
Onset age and clinical features are not typical for the described headache
Progressive and incurable vomiting
TENSION TYPE HEADACHE
It is the second most common headache after migraine. Tension type headache is a type of headache that can last from 30 minutes to 7 days and can become chronic due to continuous pain. As in other primary headaches, the age of onset is around 20 years. Nevertheless, it can be seen at any age. Although not as prominent as in migraine, it is more common in women.
Tension headaches; they are grouped as sparse, frequent and chronic and this is meaningful for the patient in terms of problem size and directing treatment.
Tension type headache with rare episodes; less than 1 day per month (less than 12 days per year). They are rare episodes of headache that can last for 30 minutes or days. Pain is typically bilateral, coercive, or compressive in nature, mild to moderate in severity, and does not worsen with routine physical activity. Nausea is not encountered; photophobia or phonophobia.
Frequent episode tension-type headache is a condition (less than 15 days per year and 12 days or more and less than 180 days), with the other characteristics being the same.
Chronic tension headache is a condition that develops daily or very frequently from episodic tension headache. Headache (180 days or more per year), which is seen for 15 days or more during the average three months, is similar in terms of other features. It is important to show that it is not associated with any other disease. It is the most common group (more than 5%) in our country and makes frequent visits to polyclinics. It has a negative effect on quality of life. The drug may lead to overuse, and in some cases it may be a problem to distinguish it from chronic migraine.
The characteristics of these criteria may not be exact in every patient. Because, pain-throbbing in about -20% of patients, 25% of the exacerbation of pain may be exacerbated by pain in approximately one case may be hemicranial pain. Because these features are features that can be confused with migraine without aura, diagnosis can sometimes be experienced. Again, in migraine headache, tension type headache features may be in the foreground. These data support the approach that migraine and tension headache are different but sometimes intertwined elements of the same spectrum. The triggering factors in tension headache are physical and psychosocial stress, menstruation, posture and position disorders, anxiety disorders and depressive disorders. Again, we should not forget the oromandibular dysfunction among the triggers and evaluate the patients in this direction.
The lifetime prevalence of Tension Headache is reported to be between 34.8% and 78%. This rate was 37.1% -88% for women and 32.3% -69% for men. In the studies conducted, annual incidence rates in western countries were between 34% and 86% for women and between 28% and 63% for men. Turkey headache epidemiology data according turkey in tension headache prevalence rates episodic tension-type headaches for 20% -30% was found to be 3.1% for chronic tension-type headache. Tension-type headache often interferes with daily life activities. However, the majority of patients do not seek medical attention. While tension-type headache patients have to quit their normal activities during the pain periods, 44% have limited daily activities.
When evaluating a patient who meets the criteria for Tension Headache, care should be taken in terms of findings for organic causes. Although it is possible to make a differential diagnosis from migraine and other primary headaches by using diagnostic criteria, especially in sudden onset headaches in patients over 50 years, in cases of progressive conditions, accompanied by fever or rash with papillary edema, changes in pain character or focal neurological findings are detected. caution should be exercised. Organic findings should be excluded by laboratory findings and neuroradiological imaging methods.
Associated Psychiatric Diseases; Coexistence of headaches and psychiatric disorders is a common condition. Psychopathologies such as depressive disorder, anxiety disorder, panic disorder and obsessive compulsive disorder have been associated with tension-type headache. Of the patients with tension type headache, 68.3% had depressive disorder, 3% had anxiety disorder, 5.5% had panic disorder, and 1.1% had obsessive compulsive disorder. Depressive disorder is observed more frequently in episodic GTBA cases.
Psychological and environmental factors are menstruation, diet, alcohol use and headache triggering conditions. Migraine with and without aura is known to be associated with menstruation. Recent publications have also indicated that there is a relationship between tension-type headache and menstruation. Depletion of alcohol and caffeine after frequent use is one of the factors that cause pain in migraine and tension headache. Insomnia is also a triggering factor in tension-type headache as in migraine.
HEADACHE TREATMENT
As in other primary headaches, the treatment approach for tension headache is two-way. On the one hand, there is acute, pain-related treatment and on the other hand, a preventive approach. If there is an episodic tension headache and the pain is rare and mild, treatment for pain should be arranged only. If chronic tension headache or frequent painful days are common, then preventive treatment should be initiated as well as treatment for pain. Most patients perform their own treatment with simple analgesics. If tension-type headache attacks become more frequent or exacerbated, seek medical attention. There are pharmacological and nonpharmacological (psychophysiological) treatment options in the treatment of tension headache.
Treatment of acute attacks to stop or reduce any attack involves the use of simple analgesics and nonsteroidal anti-inflammatory agents alone or in combination (caffeine, codeine and anxiolytics). There are many acute treatment options. The type of acute treatment depends on the frequency, severity of the headache, the associated symptoms and the presence of other concomitant diseases. Oral therapies such as analgesics, nonsteroidal antiinflammatory drugs (NSAIDs) and caffeine combined compounds are suitable for mild to moderate headache without nausea.
With the addition of muscle relaxants to analgesics, efficacy is slightly increased. Analgesic combinations, sedatives and tranchilizing / analgesic combinations have also been used in the treatment of acute tension headache. The problem or danger in the use of analgesics is the daily intake of these pharmacological agents and the occurrence of bad drug use. The other major side effect is gastric tenderness, as well as the headache itself. Acute treatments should not be used more than two days a week. Antidepressant drugs, which have been widely used in the treatment of chronic tension headache prophylaxis, are generally effective on serotonin and noradrenaline metabolism. The efficacy of commonly used tricyclic antidepressants with serotonin and noradrenaline reuptake inhibition mechanism has been demonstrated.
Non-pharmacological treatment methods are also used in the treatment of primary headache, especially tension-type headache. First of all, it is ensured that patients acquire sleep order and healthy eating habits; it is also recommended to avoid substances that can trigger headaches such as cigarettes and alcohol. The patient's mood should also be considered. Depression, anxiety, or both may accompany tension-type headache and may increase headaches. These conditions need to be recognized and treated.
Psychophysiological treatment options include relaxation exercises, biofeedback, acupuncture, hypnosis and physical therapy. Progressive relaxation training is one of the most commonly used relaxation methods. The aim of this training is to eliminate the tension in daily life. In the meta-analysis, it was stated that approaches such as relaxation training and cognitive behavioral training were effective in the treatment of tension-type headache.
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