Tension headache

Tension headaches are mild to moderate headaches that occur in the area of ​​the entire head. Of the approximately 5 % of the population who suffer according to epidemiological estimates under daily headache is a tension headache at about 40 %. Here, the episodic ( ESK ) is distinguished from chronic tension-type headache ( CSK ), corresponding to the existence of time ( see below). It may be suspected a genetic component, as in families with CSK CSK approximately three times more common than in Esk - free families.

As with any form of prolonged headache, the person concerned should keep a pain diary in which, inter alia, the following should be noted:

• The headache attacks with subjective assessment of its intensity, in each case, for example,
• By a visual analog scale (VAS) in points classification from 0 to 10 (0 = no pain, 10 = strongest / unbearable pain )
• Possibly present other problems ( nausea, vomiting, photophobia, etc.)
• The respective duration and impaired quality of life for the affected day.

This documentation helps the treating physician on the one hand asking the right diagnosis, on the other hand, the development of appropriate therapy.

Symptoms

According to the IHS criteria from 1998 can then speak of a tension headache when it concerns with the headaches to pain in the entire head (bilateral / holocephal ), the pushing - pulling one, but does not have the vibrant character. In intensity is mild to moderate pain that does not amplify during physical activity. The single headache attack has a duration between 30 minutes and 7 days. Accompanying vegetative symptoms such as photophobia and excessive noise sensitivity, nausea, vomiting and loss of appetite is not usually occur and, if so, very rarely accompany on. The distinction between Esk and CSK take place - as mentioned above - on the basis of existence Duration: Among Esk is when the SK occurred at least 10 times, but less than 180 headache days per year; from CSK speaks, as soon as the headache occurred at least 15 days a month in more than 6 consecutive months. Of delineate again is the headache which is caused by tense muscles of mastication in the head. This is also a dull - oppressive pain that seems to wander about in my head. However, it is permanent.

People with Csk are found heaped psychovegetative problems such as anxiety, depressive mood, sleep and medication overuse. More often correlating with CSK Symptoms include hair loss and Trichodynia ( itching, burning, tension, pain of the scalp ), which can also partially derived from distortions of the head, chewing and neck muscles and occur at the same time itself.

Pathogenesis

The exact pathophysiology is not known to date. It is a multifactorial suspected: On the one hand it is by a non-physiological spasm of the neck muscles to activation of pain receptors, resulting in central sensitization, causing pain are more easily perceived. On the other hand febrile infections and stress are considered as triggers and reinforcing factors. Another cause can be tense muscles of mastication in the head. This cramp by nocturnal teeth grinding (bruxism ), which in turn has psychological causes.

Diagnostics

The diagnosis must exclude all other possible primary and also secondary causes of headache. In SK there are typically no abnormalities in the general examination findings and neuroimaging (CCT, cMRI ). As part of the differential diagnosis must include an accurate internist clarification take place ( exclusion of arterial hypertension which to both sides also, dull - pressing may cause headache) and side effects of medications must be considered (eg, calcium channel blockers, nitro preparations, caffeine, certain hormones ). The exact history of use of painkillers ( analgesics ) is responsible for delineation with respect to non- analgesic -induced headache differential diagnosis of essential importance. Relatively easy it can be determined whether the patient is affected with cramped muscles of mastication suffers in the head. By pressure with the index finger to the corresponding muscles of the affected patient feels immediate pain stimulus.

Therapy

As the exact causes still lie in the dark, only symptomatic therapy as well as a preventive treatment can take place.

Episodic tension-type headache

According to the guidelines of the German Society of Neurology, the effectiveness of the following drugs for the treatment of episodic tension-type headache has been demonstrated in studies: acetylsalicylic acid (ASA ), acetaminophen, ibuprofen, naproxen, dipyrone and the fixed combination of acetylsalicylic acid, paracetamol and caffeine. The large-scale application of peppermint oil on the temples and the neck is considered to be comparable therapeutic alternative. It also offers the advantage that it can be no analgesic -induced headache. Non-pharmacological methods such as acupuncture can also be used during episodic tension-type headache. An influence on the frequency of episodic tension- type headache has not the use of acupuncture.

Chronic Tension Headache

Among the general measures include relaxation exercises, according to Jacobson, biofeedback, regular aerobic exercise, stress management training and a pain diary. The acute treatment corresponds to the treatment of episodic tension-type headache. Due to the emergence of drug- induced headache risk above should be used to a maximum of 10 days per month called analgesics.

In contrast to the episodic tension-type headache, the benefit of prophylactic treatment of chronic tension-type headache has been well studied. Tricyclic antidepressants such as amitriptyline 25-150 mg / d are in the prophylaxis as a drug of first choice. Alternatives are doxepin, imipramine or clomipramine. All of these preparations must be titrated slowly. The full effect may be interrupted only after 4-8 weeks. When preparations of the second choice, the effectiveness of which is unclear or inadequate, can be used for prophylaxis mirtazapine, venlafaxine, valproic acid, moclobemide, fluoxetine, sulpiride and topiramate. No definitive assessment are for the muscle relaxant tizanidine and the anticonvulsant gabapentin before.

The effectiveness of prophylactic, medical therapy is without flanking measures only up to 40-45 %. In combination of antidepressant and stress management training, for example, a reduction in pain in about 65 % of cases can be achieved. Also from the use of physiotherapy with training of the cervical spine and shoulder muscles, stretching and massage as well as relaxation exercises affected patients seem well placed to benefit. Carrying out acupuncture is also effective. The manner in which the acupuncture has no effect on efficacy.

Used literature

• Guideline treatment of episodic and chronic tension-type headache and other chronic daily headaches of the German Society of Neurology. In: AWMF online ( 2008)
• Neurology; Klaus Poeck, Werner Hacke; 11th edition, 2001, Springer-Verlag, pp. 427
• Basic Course Neurology; Marco Mummenthaler, Heinrich Mattle, 1st edition, 2002, Thieme, p 249