tension headache
Introduction
Introduction to tension headache Tension headache, also known as muscle contraction headache, is the most common type of headache. It is generally considered to have a higher prevalence than migraine, accounting for about half of the outpatient headaches, mainly for the neck and head and face muscles. The resulting head pressure and heavy feeling, some patients complained that the head has a "tight" feeling. basic knowledge The proportion of illness: 0.001% Susceptible people: this disease is more common in green, middle-aged Mode of infection: non-infectious Complications: insomnia
Cause
Cause of tension headache
(1) Causes of the disease
It is generally believed that tension headache is associated with a peri-cranial muscle disorder or is a mental headache. In the new classification, TTH is further subdivided into two subtypes based on the time of headache attack and the peri-cranial muscle disease:
1. episode tension-type (ETTH)
(1) Paroxysmal headaches associated with craniocerebral muscle disorders.
(2) Paroxysmal tension headaches that are not associated with craniocerebral muscle disorders.
2. Chronic tension-type (CTTH)
(1) Chronic tension-type headache associated with craniocerebral muscle disorders.
(2) Chronic tension-type headaches that are not associated with craniocerebral muscle disorders.
(two) pathogenesis
Although tension headache is a common headache, its pathogenesis has not yet been fully clarified. The research status in recent years is summarized as follows:
1. The relationship between TTH and craniocerebral muscle disease
Since the 1940s, the relationship between the two has been discussed in the literature, but whether muscle disease is the cause or result of TTH, or just one of the factors in the pathogenesis of TTH, has not yet been concluded.
Peterson et al (1995) studied a group of TTH patients for site specificity in the head pain muscles when they had a headache. They used a subjective self-report rating to detect five muscles. Including the pain of the frontal muscles, diaphragm, chewing muscles, head muscles and trapezius muscles and the degree of muscle tension, and observe the level of myoelectric activity of these muscles, although detailed quantitative observations were made for each muscle. The results did not find a significant relationship between muscle pain and muscle tone and the level of myoelectric activity. Jensen et al. (1998) used 28 cases of subtype CTTH and ETTH, which were quantified by tenderness, tenderness, and pain. The threshold and the myoelectric activity of the diaphragm and trapezius muscles were observed. The results showed that the patients with CTTH with craniocerebral muscle disease had significant tenderness and allergic reactions to mechanical stimulation pain, that is, the more obvious the tenderness, the mechanical The more sensitive the irritation response is, and the myoelectric activity is also significantly increased, but there is no abnormality in the threshold of thermal pain stimulation. The above changes are not obvious in patients with ETTH. In recent years, Bansevicius et al (1999) have muscle pain in patients with TTH. Correlation studies were also performed between pain, tension, and myoelectric response. The pain was measured on the forehead, left and right diaphragm, neck and left and right shoulder muscles using a visual analog scale (VAS). At the same time, the superficial myoelectric activity of the part is traced, and the tension and fatigue are used to ask questions. The patient self-assessment is also recorded according to the VAS method. Through the above quantitative research, it is found that between fatigue and pain, There was a significant correlation during the whole experiment. Tiredness was part of the headache, that is, the longer the headache, the more obvious the feeling of fatigue; but the correlation between tension and pain was weak, only relevant in the post-experimental period, and only seen in the neck. There is no correlation between muscle strength, muscle electrical activity and pain, between myoelectric activity and fatigue, tension and fatigue, so the authors believe that the role of tension in TTH is not prominent.
2. The relationship between TTH and psychological changes
Catheart et al. (1998) conducted an experimental study of biopsychology on the relationship between arousal-related mood and ETTH. They used activation-deactivation adjective check list (ADACL). Quantitative analysis of the energy, tiredness, tension, and calmness was performed. It was found that the level of stress in ETTH patients was higher than that in the control group, even in the absence of headache, and in non-headache In the period, the level of stress is significantly lower than the headache period, so it is considered that there is a relationship between tension and headache.
3. The relationship between TTH and vascular headache
Because clinically, it can be found that tension headache and migraine occur in the same patient at the same time, and some patients initially show migraine. When the frequency of attack increases gradually, it shows ETTH and can be converted to CTTH. Therefore, these two types of headaches There have been many reports on the relationship. For example, Tackeshima et al. (1998) pointed out that there are many similarities between muscle contraction headache and migraine when reviewing the literature. For example, the clinical symptoms and characteristics of the two can overlap each other. Platelet 5-HT can be reduced, plasma 5-HT can be elevated, the sympathetic function of the peripheral autonomic nervous system can be low, genetic studies found that the same family has both migraine and muscle contraction headache patients, etc. Recently, Hannerz et al (1998) proposed whether CTTH is a vascular headache. Their experimental study was to induce CTTH patients in supine position, using sublingual nitroglycerin and lowering the head to induce headache. As a result, the healthy control group failed. Significant headaches were induced, while headaches in CTTH patients were increased, and the diameter and blood flow of the common carotid artery were measured by a two-dimensional cervical ultrasound system. The increase in the intensity of the headache is related to the increase in the diameter of the tube, that is, the diameter of the tube is increased, the intensity of the headache is increased, the diameter of the tube is reduced, and the intensity of the headache is also weakened, but the intensity of the headache is not related to the blood flow in the blood vessel, so the author believes that the headache of the CTTH patient The occurrence is closely related to craniocerebral hemodynamics. Because the headache is slowed down after the end of the head low, it is thought that the headache is caused by insufficient intracranial venous return or venous dilatation.
4. Some biochemical observations on TTH
Some scholars have observed TTH from biochemistry and other aspects in the past years. For example, Oishi et al. (1998) detected plasma platelet factor 4, -thromboglobulin and 11-dehydrothorectin B2 levels, and found the above three substances in ETTH patients. They were significantly higher than the CTTH group and the control group, and the headache and platelet dysfunction of ETTH patients were particularly close. Mishima et al. (1997) found that serum platelet magnesium levels were decreased in patients with TTH, which may be related to the enhancement of platelet function, Martinez et al. (1994) Plasma levels of serotonin were found in patients with TTH higher than those in the control group, catecholamine levels were lower than in the control group, plasma dopamine levels were positively correlated with headache duration, and adrenaline levels were negatively correlated with headache intensity. In addition, monoamine levels and depression were also found. There is no correlation between the levels. These results suggest that there is a change in the function of the central monoaminergic nervous system in patients with TTH. This change is not related to the subsequent depression, but is related to the pathophysiological mechanism of headache. Marukawa et al. (1996) found TTH. The content of substance P and serotonin in saliva was significantly increased during the onset of headache, and it was considered that substance P was released from the pain system. .
In summary, the above examples show that the pathogenesis of TTH is still being studied in many aspects, including the relationship between headache and muscle, the relationship between headache and depression, and even tension refers to the concept of muscle tension or psychology. There are different understandings.
Prevention
Tension headache prevention
Tension headache is the most common type of headache, so it is especially important to prevent tension headache. Because the disease is related to long-term anxiety, nervousness and excessive fatigue, firstly avoid mental stimulation, regular life, prohibit smoking, alcohol, Long-term in a bad working posture, so that the head, neck and shoulder muscles can continue to shrink the headache can also occur, so develop a good habits, proper physical exercise is necessary, and for long-term chronic headache patients, in addition to psychological treatment In addition, it can also be combined with sedation, analgesics such as diazepam, ibuprofen and other drugs.
Complication
Tension headache complications Complications insomnia
Can be complicated by insomnia, depression and other intracranial complications.
Symptom
Tension headache symptoms Common symptoms face, head, neck, shoulder... Head is dull and painless, no pulsating tightening spell like head tight exam syndrome see things far away emotional headache neck stiff head top pressure tightening high blood pressure head sink
The disease is more common in young, middle-aged, children can also be sick, male and female are no difference, the symptoms at the beginning of the disease are lighter, and gradually become more serious, the clinical features of tension-type headache is dull pain, no pulsation, headache Located in the top, sputum, forehead and occipital part, sometimes there are pains in the above parts, the degree of headache is mild or moderate, not aggravated by physical activity, often complaining of heavy pressure on the head or tightness of the head. In addition, the neck of the pillow is tight and stiff, especially when turning the neck. There is no fear of light or phobia. A small number of patients are accompanied by mild irritability or depression. The examination includes no positive signs of nervous system examination, and cranial muscles such as neck occipital part. Muscle, top of the head and upper part of the shoulder muscles often have tenderness. Sometimes, the patient feels relaxed and comfortable. The CT or MRI of the brain should be normal, without high blood pressure and obvious ENT.
Examine
Tension headache check
1, EEG, EMG examination.
2, special examination of ophthalmology.
3, radionuclide (isotope) examination, X-ray examination, nuclear magnetic resonance (MRI) examination, CT examination.
Diagnosis
Diagnosis of tension headache
diagnosis
The diagnosis of tension-type headache depends mainly on the patient's description of the location, frequency and frequency of the headache. The general physical and neurological examination of the patient is normal. The disease course has been more than 1 year, and the CT or MRI of the brain is not difficult to be diagnosed. If the patient has a short course of headache, attention should be paid to the identification of various organic diseases in the brain.
Differential diagnosis
1. Migraine is a vascular headache. It is common in young and middle-aged children. The headache is located on the side of the forehead. It is pulsating and jumping, often accompanied by nausea and vomiting. It is a cerebral headache. Before the headache, there may be visual disturbances. Blurred vision, blind spots or hemianopia in the field of vision, can also start unilateral headache without any aura, generally relieved by hours or days, very few patients are migraine persistent, a few patients may be migraine and nervous Type headaches exist at the same time, so that the two are difficult to distinguish.
2. Cluster headache This type of headache may be vascular and associated with hypothalamic dysfunction. The headache is located on one side of the forehead, and the severe part spreads over the head. The headache is intense, severe and without aura, and the headache is rapid. And can suddenly stop, accompanied by conjunctival congestion, tearing, salivation and sweating, a small number of ptosis, several episodes per day, and can occur during sleep, each episode lasts tens of minutes to several hours, and It can last for several days to several weeks, but the remission period can be as long as several months to several years. It is not difficult to identify with tension headaches by asking patients detailed medical history and seizure observation.
3. Trigeminal neuralgia is a paroxysmal transient pain in the facial trigeminal nerve distribution area. Each pain is only a few seconds. It is repeated several times a day to dozens of times. The pain is like knife cutting, burning or acupuncture. It is often caused by washing your face and brushing your teeth. , speaking, chewing and induced, patients often can point out the location of the induced pain, called the "trigger point", the disease occurs in the middle, the elderly, with the third and third branches of the trigeminal nerve are more involved, if the first branch In particular, attention should be paid to the identification of ETTH.
4. Headache caused by intracranial space-occupying diseases Such diseases include intracranial tumors, intracranial metastases, brain abscesses and cerebral parasitic diseases. These headaches are caused by increased intracranial pressure and progress with the course of the disease. With jet vomiting and fundus edema, but early can be misdiagnosed as tension-type headache, for patients with short-term headache, in addition to pay attention to fundus changes, careful neurological examination is extremely important, such as the appearance of pathological signs and other signs, often Tips are not tension-type headaches should be promptly used brain CT or MRI examination to help identify.
5. Headache caused by chronic intracranial infections These diseases include tuberculous meningitis, fungal meningitis, cysticercosis (cysticercosis) meningitis and syphilitic meningitis. These meningitis are all headaches. Early symptoms are usually accompanied by fever, but some patients with atypical symptoms have low fever at the beginning and negative meningeal irritation. They are easily misdiagnosed as tension-type headaches. Therefore, when you ask for a history, as long as you have a history of "cold" or physical examination recently. Found suspicious pathological reflex, that is, timely consideration of lumbar puncture, detailed examination of cerebrospinal fluid pressure, cytology, biochemistry, tryptophan and ink staining and other routine tests, if necessary, should simultaneously detect anti-tuberculosis antibodies in blood and cerebrospinal fluid, pig pouch The cercariae (cysticercosis) immunoassay and syphilis test are used to help confirm the diagnosis.
6. Headache caused by autoimmune meningoencephalitis Such diseases include neurobehavioral disease, Vogt-Koyanagi-Harada syndrome and central nervous system sarcoidosis, which can cause inflammatory reactions when they involve the meninges or brain. Headaches, not necessarily accompanied by fever, are easily misdiagnosed as tension-type headaches. The elimination of such diseases mainly depends on detailed medical history inquiry, comprehensive physical examination and brain CT or MRI examination, and neurobehavioral disease (Neuro- Behcet's meningoencephalitis type should have the basic symptoms of the disease such as mouth, eye or external genital mucosal ulcer, Vogt-Koyanagi-Harada syndrome, also known as uveal meningoencephalitis, it should have eye damage, the number of diseases Weeks and more often accompanied by white hair, hair loss and leukoplakia and other clinical manifestations, central nervous system sarcoidosis (neurosarcoidosis) often have focal signs of the brain, and brain CT or MRI showed granulomatous lesions.
7. Headache caused by abnormal intracranial pressure Such diseases include intracranial hypotension syndrome, benign intracranial hypertension and normal intracranial pressure hydrocephalus. These patients are mainly headaches, resembling tension-type headaches, intracranial hypotension Syndrome is caused by excessive absorption or decreased secretion of cerebrospinal fluid. Dehydration and infection may be the cause of it. Benign intracranial hypertension is often accompanied by visual impairment. Excessive tetracycline or vitamin A, empty sella and pregnancy may be induced. Cranial pressure hydrocephalus is common in the recovery period after traumatic brain injury or subarachnoid hemorrhage, and its pathogenesis may be related to cerebrospinal fluid absorption disorder. Such diseases can be identified by lumbar puncture to measure intracranial pressure and brain CT examination.
