Tension headache. Let us get a second look

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Introduction. Tension headache (TH) is the most frequent type of headache. The overall amounts of patients’ disadaptation and social and economic damage caused by TH are more significant than ones caused by migraine. TH diagnostics and treatment are a challenge in outpatient conditions. Aim. To analyze in detail pathogenic mechanisms and chronification factors, and to generalize therapeutic approaches to TH treatment. Materials and methods. Materials from Russian and foreign publications for the last 20 years (PubMed, eLIBRARY and others) as well as clinical guidelines on TH diagnostics and treatment were systematized. Results. According to the results of a population study conducted in Russia in 2009-2011, TH prevalence rate was 30.8% over one year. TH is subdivided into infrequent, frequent and chronic headache. Apart from that, episodic and chronic TH with and without “tension” of pericranial muscles determined by palpation are distinguished. The studies conducted in recent years confirmed neurobiological genesis of TH. Peripheral as well as central mechanisms are involved in its genesis. The main risk factors of TH development include inability of psychological and muscular relaxation and insufficient nocturnal sleep. Emotional stress and pose strain are the most frequent predisposing factors. We thoroughly analyzed data of randomized controlled studies of rapid relief of TH symptoms and identified the most frequently used medications among which ketoprofen (Ketonal®) occupies an important place. Chronic or frequent episodic TH is indication for TH prevention therapy prescription. Antidepressants such as amitriptyline are considered the first choice medications for chronic TH treatment, mirtazapine and venlafaxine are of lower effectiveness. The third choice therapy includes other tricyclic and tetracyclic antidepressants, clomipramine, maprotiline, and mianserine. Effectiveness of muscle relaxant tizanidine use, dosage and duration of its use in TH treatment, possibilities of monotherapy and combination with antidepressants are discussed. Among non-pharmacological treatment methods biofeedback and cognitive behavior therapy are considered the most effective ones. Conclusion. Combination therapy, including non-pharmacological treatment methods along with pharmacotherapy, remains the most effective method of TH treatment.

About the authors

Margarita V. Naprienko

Alexandr Wayne Clinic of Headache and Autonomic Disorders; I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: mv_naprienko@mail.ru
D. Sci. (Med.), Assoc. Prof.; Chief doctor Moscow, Russia

Elena G. Filatova

Alexandr Wayne Clinic of Headache and Autonomic Disorders; I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: eg-filatova@mail.ru
D. Sci. (Med.), Prof., Chief doctor Moscow, Russia

Larisa V. Smekalkina

I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

D. Sci. (Med.), Full Prof Moscow, Russia

Sergei A. Makarov

I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Аssistant Moscow, Russia

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