Headache pathophysiology imaging and neurophysiology ep01002 chronic migraine is mediated by the hypothalamus laura schulte1, angie allers1 and arne may1 1department of systems neuroscience, university medical center eppendorf, hamburg, germany objectives. Guidelines for trials of drug treatments in tensiontype headache. Guidelines for trials of drug treatments in tensiontype headache 5 found in the ihs classification 1. The former episodic tensiontype headache etth is further classified into 2. Although a unifying pathophysiologic explanation of cluster headache is not yet. Tth is the most common type of chronic recurring head pain. In the past, pain etiology was presumed to be the muscular contraction of painsensitive structures of the cranium, but the ihs intentionally abandoned the terms muscular contraction headache and tension headache because no research supports muscular contraction as the sole pain etiology. The typical presentation of a tth attack is that of a mild to moderate intensity, bilateral, nonthrobbing headache without other associated features. Diagnosis of tension type headache is based on characteristic symptoms and a normal physical examination, which includes a. Yet our knowledge regarding tth pathophysiological mechanisms is still in its early stages.
Clinical syndromes, pathophysiology and management joanna g katzman, m. Diagnosis, pathophysiology, and management of cluster. Clinical reasoning for manual therapy management of tension type and cervicogenic headache combined sections meeting 2016 anaheim, california, february 17 20, 2016 carol a. There are many reasons why patients with tth overuse acute medications, including biobehavioral influences, dependency, and a lack of patient education. Tensiontype headache merck manuals professional edition. An optimal reading and support relevant research in the area. The complete headache chart type symptoms precipitating factors treatment prevention hangover headaches migraine. Tension type headache tth is the most prevalent headache in the general population, and the secondmost prevalent disorder in the world. Physical exhaustion is also a common cause of tth, so make sure you are getting enough sleep. Both migraine and tension type headache tth are common primary headache disorders in the population. Headache pathophysiology imaging and neurophysiology. The most common causes of tth reported are anxiety, emotional stress, depression, poor posture, and lack of sleep, although the evidence for each of these except stress is poor.
Efns guideline on the treatment of tensiontype headache report of an efns task force l. Tension headache is the most common primary headache and accounts for 90% of all headaches. For comparison 203 patients with tension type headache tth and 74 with chronic tth, 73 with trigeminal autonomic cephalalgias tacs, 42 with new daily persistent headache ndph were also evaluated. Aug 16, 2017 headache attributed to airplane travel, also named airplane headache ah is a headache that occurs during takeoff and landing. Tension type headache is one of the most common primary headache disorders. Both peripheral and central factors may play a role. Conclusion a clinical practice guideline for the canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidenceinformed care for patients with headache. Acute treatment and tensiontype headache in adults. The pathophysiology of tensiontype headache is still far from clear, although recent advances in basic and clinical research have increased our knowledge about mechanisms underlying this disorder. Guidelines for trials of drug treatments in tension type headache 7 should be performed in accordance with the latest version of the declaration of helsinki. Additional diagnostic workup is especially important in patients with additional symptoms other than headache. The use of placebo is justifiable in high quality trials or if the scientific question cannot be resolved without the use of placebo see sections on trial design, 2.
In the us population, the estimated annual prevalence for episodic tension type headache is 38. Advances in basic pain and clinical research have improved our understanding of pathophysiologic mechanisms of tension type headache. The pathophysiology of tensiontype headache when making a diagnosis of tensiontype headache, the following factors are particularly important. Guideline for primary care management of headache in adults. This textbook will assess both clinical and research aspects of the diagnosis and management of two highly prevalent headache disorders. Headache is the symptom of pain in the face, head, or neck. However, the progress in basic and clinical research has increased our understanding of the mechanisms of migraine. Primary headache classification, pathophysiology, and. Tensiontype headaches most commonly last from 30 minutes to seven days. Pathophysiology of tensiontype headache springerlink. Increased excitability of the central nervous system generated by repetitive and sustained pericranial myofascial input may be responsible for the transformation of episodic tension type. Tth is the most common type of headache, and it is classified as episodic etth or chronic ctth. This book provides a detailed overview of the current state of knowledge regarding the pathophysiology of both primary headaches migraine, tensiontype headache tth, and cluster headache and the very important and frequent type of secondary headache, medication overuse headache moh.
The diagnosis is based on the history and examination. Tension type headache is not as well studied as migraine and was once thought to be primarily psychogenic. Chronic tension type headache, coexisting migraine, sleep problems and not being married were identified as risk factors for a poor outcome. An important factor in the longterm prognosis of tth is the overuse of acute medications used to treat headache. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Chronic tensiontype headache, cns, nos inhibitors, antinociceptive, no donor glyceryl trinitrate. Marc disabella, do, discusses primary headaches, their classification, pathophysiology, and lifestyle modification basics at a childrens national webinar. Courtney pt, phd, faaompt cesar fernandezdelaspenas pt, phd emilio puentedura pt, phd, faaompt joshua cleland pt, phd, faaompt disclosure. Tensiontype headache definition tensiontype headache tth is the most common form of headache. Headache is considered primary when a disease or other medical condition does not cause the headache. Tensiontype headache neurologic disorders merck manuals. The common feature of all these pain syndromes is that they involve the regions of the body innervated by the trigeminal nerve and the upper cervical nerves, as. Tensiontype headache pain is usually experienced as a band extending bilaterally back from the forehead across the sides of the head to the occiput and may extend to the posterior. Nitric oxide may play a key role in the pathophysiology of tension.
It can be categorized into three subtypes according to the international classification of headache disorders based on headache frequency. The chronic type cch is defined by attacks that occur daily for more than. Fundamental to the concept of idiopathic or primary headache, including migraine, tensiontype headache and cluster headache, is the currently accepted view that these conditions are due to. Guidelines for trials of drug treatments in tensiontype. Episodic tth etth can also be frequent type and nonfrequent type. Despite these apparently straightforward criteria, and that th is the most frequent headache type in the general population 6, it remains the least characteristic of all headache types, its clinical diagnosis based. Migraine headaches are described as throbbing headaches that get worse with activity. The prognosis is fairly favorable for the episodic forms. Chronic tensiontype headache goteborgs universitet. Cluster headache is a form of primary neurovascular headache with the following features. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head.
Advances in basic pain and clinical research have improved our understanding of pathophysiologic mechanisms of tensiontype headache. I hope you like it slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. As discussed at the outset, most of the patients of infrequent episodic tension type headache will not report to the physicians and usually take overthecounter analgesics. Tension type headache tth is the most prevalent primary headache disorder. Tension type headaches are the most common, affecting upwards of 75% of all headache sufferers.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Pathophysiology, diagnostic criteria and treatment. Headache 1 diagnosis, pathophysiology, and management of cluster headache jan hoffmann, arne may cluster headache is a trigeminal autonomic cephalalgiacharacterised by extremely painful, strictly unilateral, shortlasting headache attacks accompanied by ipsilateral autonomic symptoms or the sense of restlessness and agitation, or both. Pathophysiology of headacheprimary headachessecondary. Consider the following cant miss headache causes at least once in your evaluation of a newonset headache or a. Over the past few decades research on headache has centred on migraine, and much of the best quality evidence for the treatment of tension type headache is decades old. Tension type headache tth which is a primary headache has episodic and chronic forms. Calcitonin generelated peptide cgrp seems to have essential importance concerning migraine and cluster headache. Nausea and vomiting if present, rules out the diagnosis of tension type headache. Its clinical diagnosis is based chiefly on negative features that is, absence of symptoms that characterize other primary or secondary headaches. Previous reports of sensitization of the central nervous system in patients.
The international classification of headache disorders, 2nd edition cephalalgia 2004. In this article, the epidemiology and diagnostic challenges of tth are presented and discussed. May 21, 2019 tension type headache tth represents one of the most costly diseases because of its very high prevalence. After tension headache, the second most frequently. May 25, 2018 headache is considered primary when a disease or other medical condition does not cause the headache. It is also one of the most neglected headache types and 2, in its chronic form, chronic tension type headache ctth is one of the most difficult types of headache to treat 1.
Although tension type headache is present in up to 78% of headache patients in populationbased studies, it is the least distinct of all headache types. Nov 21, 2017 tth is the most common type of chronic recurring head pain. Tensiontype headache tth is the most prevalent headache in the general population, and the secondmost prevalent disorder in the world. These red flag symptoms mean that a headache warrants further investigation with. Tensiontype headache msd manual professional edition. Head pain referral during examination of the neck in. Excellent book containing updated research on tensiontype headache and cervicogenic, with optimal organization of the chapter by relevant topics, from the neurophysiological basis of all components that involve pain to the main research treatments for these types of headache. Nevertheless pathophysiology of single diseases is unexplained. Headache pathophysiology imaging and neurophysiology, 2017. Efns guideline on the treatment of tensiontype headache. Psychological stress and weak coping mechanisms may initiate and propagate physiological pain via activation of second messengers in downstream substrates involved in pain.
Tension type headache causes mild generalized pain without the incapacity, nausea, or photophobia associated with migraine. Systemic hypertension, headache, and ocular hemodynamics. Apr 03, 2017 marc disabella, do, discusses primary headaches, their classification, pathophysiology, and lifestyle modification basics at a childrens national webinar. Tensiontype headache tth american migraine foundation. It can occur as a migraine, tensiontype headache, or cluster headache. Today, there are still uncertainties about the pathophysiology and treatment of ah. International classification of headache disorders ichd headaches primary secondary. The most common types of chronic daily headache are chronic migraines and. This is the first book for the new series contemporary issues in physical therapy and rehabilitation medicine.
A rather characteristic earlymorning pulsating headache is commonly seen in hypertensive patients, and a recent metaanalysis supports the link between these 2 entities. Chronic daily headache is defined as the presence of a headache on 15 days or more per month for at least three months. The pathophysiology of tension type headache when making a diagnosis of tension type headache, the following factors are particularly important. Both migraine and tensiontype headache tth are common primary headache disorders in the population. The chronic form of cluster headache lacks remissions and is diagnosed after a year without remission, or if remission has lasted less than 30 days.
Tensiontype headache is one of the most common primary headache disorders. Increased excitability of the central nervous system generated by repetitive and sustained pericranial myofascial input may be. For patients with frequent episodic tension type headache, simple analgesics and nsaidss are the mainstays in the acute therapy. The international classification of headache disorders. Migraine headache arises from activation and sensibilization of trigeminal nociceptors, essential processes are located at the meninges and the meningeal vessels. But it is a complicated type of headache that actually begins before the pain is felt. Pathophysiology of headacheprimary headachessecondary headaches. The national headache foundation is a leader in headache and migraine awareness, providing headache research and migraine research and resources for those suffering with severe migraines and headaches. Headache is much more than migraine alone, and facial pain is often included in the discussion of headache. The most common disabling primary headaches are migraine and cluster headache. Headache is a broad term that encompasses most of the pain syndromes that involve the head and upper neck.
To investigate if and to what extent typical head pain can be reproduced in tension. Schoenenf adepartment of neurology, danish headache centre, glostrup hospital, university of copenhagen, copenhagen, denmark. It occurs in attacks typically of less than 3 h in length and in bouts clusters of a few months during. Excellent book containing updated research on tension type headache and cervicogenic, with optimal organization of the chapter by relevant topics, from the neurophysiological basis of all components that involve pain to the main research treatments for these types of headache. Recent progress in basic and clinical research has improved understanding of pathophysiological mechanisms of tension. Alcohol, which causes dilation and irritation of the blood vessels of the brain and surrounding tissue. Advances in the pathophysiology of tensiontype headache. Pathophysiology of migraine and tensiontype headache. Tension headache is the most common type of headache, with a reported lifetime prevalence as high as 78%. Migraine is likely due to a disturbance in the brain stemdiencephalic aminergic sensory modulation systems, whereas cluster headache is a disorder of hypothalamic control. Tension type headache should be distinguished from a forme fruste of migraine, which many patients with migraine have. While both muscular and psychogenic factors are believed to be associated with tensiontype headache, most are felt to be multifactorial.
Tension type headache danish headache center type headache nonpharmacological and pharmacological treatment lars bendtsen associate professor, md, phd, dr med sci danish headache center, department of neurology glostrup hospital, univers ity of copenhagen, denmark european headache school, belgrade, may, 2012 treatment 1200 bc drawing by p. Chronic tension type headache 2 2 introduction tension type headache tth is the most common type of headache and has a high socioeconomic impact 1. As many as 90% of adults have had tension type headache these headaches are typically a steady ache rather than a throbbing one, and affect both sides of the head distracting but usually not debilitating. Matheson, md, medical university of south carolina, charleston. The association between systemic hypertension and headache remains controversial and its pathophysiologic basis is uncertain. Peripheral pain mechanisms are most likely to play a role in 2. Schoenen, what is your comment on headache progression. Tension type headache tth is the most common and most socioeconomically costly headache. Tension headache, also known as tension type headache tth or stress headache, is the most common type of primary headache.
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