Gerilim Tipi Baş Ağrısı
Özet
Gerilim tipi baş ağrısı (GTBA), dünya çapında en yaygın görülen nörolojik ve primer baş ağrısı bozukluğudur. Hafif veya orta şiddette, iki taraflı yerleşimli, sıkıştırıcı nitelikte olan bu ağrı, rutin fiziksel aktiviteyle şiddetlenmez. Uluslararası Baş Ağrısı Bozuklukları Sınıflandırması (ICHD-3), GTBA'yı sıklığına göre seyrek epizodik, sık epizodik ve kronik olmak üzere üç ana alt tipe ayırır. Tanı, hasta öyküsü ve klinik kriterlerle alternatif tanıların dışlanmasıyla konur. Genç yaş, kadın cinsiyeti ve stres gibi psikojenik faktörler önemli risk unsurlarıdır. Hastalığın patofizyolojisinde genetik etmenler ile santral ve periferik miyofasiyal mekanizmalar rol oynamaktadır. Tedavi yaklaşımı akut atak ve önleyici (profilaktik) tedavi olarak ikiye ayrılır. Akut dönemde ibuprofen, ketoprofen ve asetaminofen gibi basit veya kombine analjezikler tercih edilirken; kronik ve sık epizodik vakalarda başta amitriptilin olmak üzere antidepresanlar önleyici olarak kullanılır. İlaçların doz artırımı ve kesilmesi yavaşça yapılmalıdır. Ayrıca bilişsel davranışçı terapi, biofeedback, gevşeme egzersizleri ve akupunktur gibi farmakolojik olmayan yöntemler de profilakside kombine tedavi olarak önerilir. Kronikleşme, depresyon ve ilaç kötü kullanımı ise hastalığın prognozunu olumsuz etkilemektedir.
Tension-type headache (TTH) is the most common neurological and primary headache disorder worldwide. Characterized by mild to moderate, bilateral, and pressing-tightening pain, it does not worsen with routine physical activity. The International Classification of Headache Disorders (ICHD-3) divides TTH into three main subtypes based on frequency: infrequent episodic, frequent episodic, and chronic. Diagnosis is established through headache history and clinical criteria by excluding alternative diagnoses. Young age, female gender, and psychogenic factors such as stress are significant risk factors. Genetic elements along with central and peripheral myofascial mechanisms play a role in its pathophysiology. Treatment is evaluated under acute attack and preventive (prophylactic) therapy. In the acute phase, simple or combined analgesics such as ibuprofen, ketoprofen, and acetaminophen are preferred; whereas in chronic and frequent episodic cases, antidepressants, primarily amitriptyline, are used preventively. Medication dosage titration and discontinuation must be done gradually. Additionally, non-pharmacological methods including cognitive behavioral therapy, biofeedback, relaxation exercises, and acupuncture are recommended as combined therapies in prophylaxis. Chronification, depression, and medication overuse negatively affect the prognosis of the disease.
Referanslar
Ashina S, Mitsikostas DD, Lee MJ, et al. Tension-type headache. Nature Reviews Disease Primers. 2021;7(1). doi:10.1038/s41572-021-00257-2
Çoşkun Ö. Gerilim Tipi Başağrısı. In: İnan LE (ed.) Nörolojide Yeni Ufuklar Başağrıları. Ankara: Güneş Tıp Kitabevleri; 2011. p. 63–79.
Olesen J. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1): 1–211. doi:10.1177/0333102417738202
Jensen RH. Tension-Type Headache – The Normal and Most Prevalent Headache. Headache. 2018;58(2): 339–345. doi:10.1111/head.13067
Rasmussen BK, Jensen R, Schroll M, et al. Epidemiology of headache in a general population-A prevalence study. Journal of Clinical Epidemiology. 1991;44(11): 1147–1157. doi:10.1016/0895-4356(91)90147-2
Rasmussen BK, Jensen R, Olesen J. Impact of headache on sickness absence and utilisation of medical services: A Danish population study. Journal of Epidemiology and Community Health. 1992;46(4): 443–446. doi:10.1136/jech.46.4.443
Aaseth K, Grande RB, Lundqvist C, et al. Pericranial tenderness in chronic tension-type headache: the Akershus population-based study of chronic headache. Journal of Headache and Pain. 2014;15(1): 1–7. doi:10.1186/1129-2377-15-58
Deuschl G, Beghi E, Fazekas F, et al. The burden of neurological diseases in Europe: an analysis for the Global Burden of Disease Study 2017. The Lancet Public Health. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license; 2020;5(10): e551–e567. doi:10.1016/S2468-2667(20)30190-0
Feigin VL, Vos T, Alahdab F, et al. Burden of Neurological Disorders across the US from 1990-2017: A Global Burden of Disease Study. JAMA Neurology. 2021;78(2): 165–176. doi:10.1001/jamaneurol.2020.4152
Lyngberg AC, Rasmussen BK, Jørgensen T, et al. Incidence of primary headache: A Danish epidemiologic follow-up study. American Journal of Epidemiology. 2005;161(11): 1066–1073. doi:10.1093/aje/kwi139
Stovner LJ, Hagen K, Jensen R, et al. The global burden of headache: A documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27(3): 193–210. doi:10.1111/j.1468-2982.2007.01288.x
Wang SJ, Fuh JL, Lu SR, et al. Chronic daily headache in Chinese elderly: Prevalence, risk factors, and biannual follow-up. Neurology. 2000;54(2): 314–319. doi:10.1212/wnl.54.2.314
Lyngberg AC, Rasmussen BK, Jørgensen T, et al. Prognosis of migraine and tension-type headache: A population-based follow-up study. Neurology. 2005;65(4): 580–585. doi:10.1212/01.wnl.0000172918.74999.8a
Jensen R, Stovner LJ. Epidemiology and comorbidity of headache. The Lancet Neurology. 2008;7(4): 354–361. doi:10.1016/S1474-4422(08)70062-0
Ødegård SS, Engstrøm M, Sand T, et al. Associations between sleep disturbance and primary headaches: the third Nord-Trøndelag Health Study. The journal of headache and pain. 2010;11(3): 197–206. doi:10.1007/s10194-010-0201-8
Song TJ, Cho SJ, Kim WJ, et al. Anxiety and depression in tension-type headache: A population-based study. PLoS ONE. 2016;11(10): 1–12. doi:10.1371/journal.pone.0165316
Mitsikostas DD, Thomas AM. Comorbidity of headache and depressive disorders. Cephalalgia. 1999;19(4): 211–217. doi:10.1046/j.1468-2982.1999.019004211.x
Yoon MS, Manack A, Schramm S, et al. Chronic migraine and chronic tension-type headache are associated with concomitant low back pain: Results of the German Headache Consortium study. Pain. 2013;154(3): 484–492. doi:10.1016/j.pain.2012.12.010
Ashina S, Lipton RB, Bendtsen L, et al. Increased pain sensitivity in migraine and tension-type headache coexistent with low back pain: A cross-sectional population study. European Journal of Pain (United Kingdom). 2018;22(5): 904–914. doi:10.1002/ejp.1176
Ashina S, Bendtsen L, Lyngberg AC, et al. Prevalence of neck pain in migraine and tension-type headache: A population study. Cephalalgia. 2015;35(3): 211–219. doi:10.1177/0333102414535110
De Tommaso M, Federici A, Serpino C, et al. Clinical features of headache patients with fibromyalgia comorbidity. Journal of Headache and Pain. 2011;12(6): 629–638. doi:10.1007/s10194-011-0377-6
Ulrich V, Gervil M, Olesen J. The relative influence of environment and genes in episodic tension-type headache. Neurology. 2004;62(11): 2065–2069. doi:10.1212/01.WNL.0000129498.50793.8A
Russell MB, Levi N, Kaprio J. Genetics of tension-type headache: A population based twin study. American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics. 2007;144(8): 982–986. doi:10.1002/ajmg.b.30497
Russell MB, Šaltyte-Benth J, Levi N. Are infrequent episodic, frequent episodicand chronic tension-type headache inherited? A population-based study of 11 199 twin pairs. Journal of Headache and Pain. 2006;7(3): 119–126. doi:10.1007/s10194-006-0299-x
Østergaard S, Russell MB, Bendtsen L, et al. A quantitative systematic review of ondansetron in treatment of established postoperative nausea and vomiting. BMJ (Clinical research ed.). 1997;314(7087): 1092–1093. doi:10.1136/bmj.314.7087.1088
Fernández-De-Las-Peñas C, Ambite-Quesada S, Rivas-Martínez I, et al. Genetic contribution of catechol-o-methyltransferase polymorphism (Val158Met) in children with chronic tension-type headache. Pediatric Research. 2011;70(4): 395–399. doi:10.1203/PDR.0b013e318229448a
Fernández-De-Las-Peñas C, Ambite-Quesada S, Florencio LL, et al. Catechol-O-Methyltransferase Val158Met Polymorphism Is Associated with Anxiety, Depression, and Widespread Pressure Pain Sensitivity in Women with Chronic, but Not Episodic, Migraine. Pain Medicine (United States). 2019;20(7): 1409–1417. doi:10.1093/pm/pny237
Jeong WP, Joong SK, Hae KL, et al. Serotonin transporter polymorphism and harm avoidance personality in chronic tension-type headache. Headache. 2004;44(10): 1005–1009. doi:10.1111/j.1526-4610.2004.04194.x
Gupta R, Kumar V, Luthra K, et al. Polymorphism in apolipoprotein E among migraineurs and tension-type headache subjects. Journal of Headache and Pain. 2009;10(2): 115–120. doi:10.1007/s10194-008-0094-y
Jensen R. Peripheral and central mechanisms in tension-type headache: An update. Cephalalgia, Supplement. 2003;23(1): 49–52. doi:10.1046/j.1468-2982.2003.00574.x
Langemark M, Olesen J. Pericranial Tenderness in Tension Headache: A Blind, Controlled Study. Cephalalgia. 1987;7(4): 249–255. doi:10.1046/j.1468-2982.1987.0704249.x
Jensen R, Rasmussen BK, Pedersen B, et al. Muscle tenderness and pressure pain thresholds in headache. A population study. Pain. 1993;52(2): 193–199. doi:10.1016/0304-3959(93)90131-8
Ashina M, Bendtsen L, Jensen R, et al. Muscle hardness in patients with chronic tension-type headache: Relation to actual headache state. Pain. 1999;79(2–3): 201–205. doi:10.1016/S0304-3959(98)00167-5
Fernández-De-Las-Peñas C, Arendt-Nielsen L. Improving understanding of trigger points and widespread pressure pain sensitivity in tension-type headache patients: clinical implications. Expert Review of Neurotherapeutics. Taylor & Francis; 2017;17(9): 933–939. doi:10.1080/14737175.2017.1359088
Palacios-Ceña M, Wang K, Castaldo M, et al. Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache. Cephalalgia. 2018;38(2): 237–245. doi:10.1177/0333102416679965
Bendtsen L, Fernández-De-La-Peñas C. The role of muscles in tension-type headache. Current Pain and Headache Reports. 2011;15(6): 451–458. doi:10.1007/s11916-011-0216-0
Henriksson K, Lindman R. No Title. In: Olesen J, Schoenen J (eds.) Tension-type headache classification, mechanisms, and treatment. 3rd ed. New York: Raven Press; 1993. p. 97–107.
Fernández-de-las-Peñas C. Myofascial Head Pain. Current Pain and Headache Reports. 2015;19(7): 1–7. doi:10.1007/s11916-015-0503-2
Ashina M, Stallknecht B, Bendtsen L, et al. Tender points are not sites of ongoing inflammation - In vivo evidence in patients with chronic tension-type headache. Cephalalgia. 2003;23(2): 109–116. doi:10.1046/j.1468-2982.2003.00520.x
Schytz HW, Amin FM, Selb J, et al. Non-invasive methods for measuring vascular changes in neurovascular headaches. Journal of Cerebral Blood Flow and Metabolism. 2019;39(4): 633–649. doi:10.1177/0271678X17724138
Fernández-de-las-Peñas C, Plaza-Manzano G, Navarro-Santana MJ, et al. Evidence of localized and widespread pressure pain hypersensitivity in patients with tension-type headache: A systematic review and meta-analysis. Cephalalgia. 2021;41(2): 256–273. doi:10.1177/0333102420958384
Ashina S, Bendtsen L, Ashina M, et al. Generalized hyperalgesia in patients with chronic tension-type headache. Cephalalgia. 2006;26(8): 940–948. doi:10.1111/j.1468-2982.2006.01150.x
Bendtsen L, Jensen R. Tension-Type Headache. Neurologic Clinics. 2009;27(2): 525–535. doi:10.1016/j.ncl.2008.11.010
Bezov D, Ashina S, Jensen R, et al. Pain perception studies in tension-type headache. Headache. 2011;51(2): 262–271. doi:10.1111/j.1526-4610.2010.01768.x
Chen WT, Hsiao FJ, Ko YC, et al. Comparison of somatosensory cortex excitability between migraine and ‘strict-criteria’ tension-type headache: A magnetoencephalographic study. [Online] Pain. 2018. 793–803 p. doi:10.1097/j.pain.0000000000001151
Buchgreitz L, Lyngberg AC, Bendtsen L, et al. Increased pain sensitivity is not a risk factor but a consequence of frequent headache: A population-based follow-up study. Pain. 2008;137(3): 623–630. doi:10.1016/j.pain.2007.10.023
Buchgreitz L, Lyngberg AC, Bendtsen L, et al. Frequency of headache is related to sensitization: A population study. Pain. 2006;123(1–2): 19–27. doi:10.1016/j.pain.2006.01.040
Bendtsen L, Jensen R, Olesen J. Qualitatively altered nociception in chronic myofascial pain. Pain. 1996;65(2–3): 259–264. doi:10.1016/0304-3959(95)00239-1
Rossi P, Vollono C, Valeriani M, et al. The contribution of clinical neurophysiology to the comprehension of the tension-type headache mechanisms. Clinical Neurophysiology. International Federation of Clinical Neurophysiology; 2011;122(6): 1075–1085. doi:10.1016/j.clinph.2010.12.061
Ashina M. Neurobiology of chronic tension-type headache. Cephalalgia. 2004;24(3): 161–172. doi:10.1111/j.1468-2982.2003.00644.x
Ashina M, Bendtsen L, Jensen R, et al. Nitric oxide-induced headache in patients with chronic tension-type headache. Brain. 2000;123(9): 1830–1837. doi:10.1093/brain/123.9.1830
Sarchielli P, Alberti A, Floridi A, et al. L-Arginine/nitric oxide pathway in chronic tension-type headache: Relation with serotonin content and secretion and glutamate content. Journal of the Neurological Sciences. 2002;198(1–2): 9–15. doi:10.1016/S0022-510X(02)00035-7
D’Andrea G, Hasselmark L, Cananzi AR, et al. Metabolism and Menstrual Cycle Rhythmicity of Serotonin in Primary Headaches. Headache: The Journal of Head and Face Pain. 1995;35(4): 216–221. doi:10.1111/j.1526-4610.1995.hed3504216.x
Bendtsen L, Jensen R, Hindberg I, et al. Serotonin metabolism in chronic tension-type headache. Cephalalgia. 1997;17(8): 843–848. doi:10.1046/j.1468-2982.1997.1708843.x
Uddman R, Edvinsson L, Jansen I, et al. Peptide-containing nerve fibres in human extracranial tissue: a morphological basis for neuropeptide involvement in extracranial pain? Pain. 1986;27(3): 391–399. doi:10.1016/0304-3959(86)90162-4
Ashina M, Bendtsen L, Jensen R, et al. Plasma levels of substance P, neuropeptide Y and vasoactive intestinal polypeptide in patients with chronic tension-type headache. Pain. 1999;83(3): 541–547. doi:10.1016/S0304-3959(99)00159-1
Rasmussen BK, Jensen R, Olesen J. Questionnaire Versus Clinical Interview in the Diagnosis of Headache. Headache: The Journal of Head and Face Pain. 1991;31(5): 290–295. doi:10.1111/j.1526-4610.1991.hed3105290.x
Chen WT, Chou KH, Lee PL, et al. Comparison of gray matter volume between migraine and “strict-criteria” tension-type headache. Journal of Headache and Pain. The Journal of Headache and Pain; 2018;19(1). doi:10.1186/s10194-018-0834-6
Schmidt-Wilcke T, Leinisch E, Straube A, et al. Gray matter decrease in patients with chronic tension type headache. Neurology. 2005;65(9): 1483–1486. doi:10.1212/01.wnl.0000183067.94400.80
Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology. 2019;92(3): 134–144. doi:10.1212/WNL.0000000000006697
Howard L, Wessely S, Leese M, et al. Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache. Journal of Neurology, Neurosurgery and Psychiatry. 2005;76(11): 1558–1564. doi:10.1136/jnnp.2004.057851
Hagen K, Jensen R, Bøe MG, et al. Medication overuse headache: A critical review of end points in recent follow-up studies. Journal of Headache and Pain. 2010;11(5): 373–377. doi:10.1007/s10194-010-0221-4
Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headache - Report of an EFNS task force. European Journal of Neurology. 2010;17(11): 1318–1325. doi:10.1111/j.1468-1331.2010.03070.x
Starling AJ. Diagnosis and Management of Headache in Older Adults. Mayo Clinic Proceedings. Mayo Foundation for Medical Education and Research; 2018;93(2): 252–262. doi:10.1016/j.mayocp.2017.12.002
Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology. 2004;62(10): 1706–1711. doi:10.1212/01.WNL.0000127282.90920.8C
Zissis NP, Harmoussi S, Vlaikidis N, et al. A randomized, double-blind, placebo-controlled study of venlafaxine XR in out-patients with tension-type headache. Cephalalgia. 2007;27(4): 315–324. doi:10.1111/j.1468-2982.2007.01300.x
Murros K, Kataja M, Hedman C, et al. Modified-release formulation of tizanidine in chronic tension-type headache. Headache. 2000;40(8): 633–637. doi:10.1046/j.1526-4610.2000.040008633.x
Hospital A, Mitsikostas DD, Hospital G. Buspirone vs amitriptyline in the treatment. 1997;(ll): 247–251.
Lenaerts M, Bastings E, Sianard J, et al. Sodium valproate in severe migraine and tension-type headache: an open study of long-term efficacy and correlation with blood levels. Acta Neurol Belg. 1996;
Lampl C, Marecek S, May A, et al. A prospective, open-label, long-term study of the efficacy and tolerability of topiramate in the prophylaxis of chronic tension-type headache. Cephalalgia. 2006;26(10): 1203–1208. doi:10.1111/j.1468-2982.2006.01193.x
Derry S, Wiffen PJ, Moore RA, et al. Ibuprofen for acute treatment of episodic tension-type headache in adults. Cochrane Database of Systematic Reviews. 2015;2015(1). doi:10.1002/14651858.CD011474
Veys L, Derry S, Moore RA. Ketoprofen for episodic tension-type headache in adults. Cochrane Database of Systematic Reviews. 2016;2016(9). doi:10.1002/14651858.CD012190.pub2
Prior MJ, Cooper KM, May LG, et al. Efficacy and safety of acetaminophen and naproxen in the treatment of tension-type headache. A randomized, double-blind, placebo-controlled trial. Cephalalgia. 2002;22(9): 740–748. doi:10.1046/j.1468-2982.2002.00419.x
Kubitzek F, Ziegler G, Gold MS, et al. Low-dose diclofenac potassium in the treatment of episodic tension-type headache. European Journal of Pain. 2003;7(2): 155–162. doi:10.1016/S1090-3801(02)00094-0
Stephens G, Derry S, Moore RA. Paracetamol (acetaminophen) for acute treatment of episodic tension-type headache in adults. Cochrane Database of Systematic Reviews. 2016;2016(6). doi:10.1002/14651858.CD011889.pub2
Derry S, Wiffen PJ, Moore RA. Aspirin for acute treatment of episodic tension-type headache in adults. Cochrane Database of Systematic Reviews. 2017;2019(5). doi:10.1002/14651858.CD011888.pub2
Diener HC, Gold M, Hagen M. Use of a fixed combination of acetylsalicylic acid, acetaminophen and caffeine compared with acetaminophen alone in episodic tension-type headache: meta-analysis of four randomized, double-blind, placebo-controlled, crossover studies. Journal of Headache and Pain. 2014;15(1): 1–10. doi:10.1186/1129-2377-15-76
Andrasik F, Grazzi L, Sansone E, et al. Non -pharmacological approaches for headaches in young age: An updated review. Frontiers in Neurology. 2018;9(NOV): 1–8. doi:10.3389/fneur.2018.01009
Holroyd KA, Donnell FJO, Stensland M, et al. Management of Chronic Tension-Type. 2015;285(17): 2208–2215.
Espí-López G V., Zurriaga-Llorens R, Monzani L, et al. The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial. Eur. J. Phys. Rehabil. Med. 2016;52: 606–617.
Maistrello LF, Geri T, Gianola S, et al. Effectiveness of trigger point manual treatment on the frequency, intensity, and duration of attacks in primary headaches: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Neurology. 2018;9(APR). doi:10.3389/fneur.2018.00254
Linde K. Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews. 2016;
Karadaş Ö, Gül HL, Inan LE. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache. Journal of Headache and Pain. 2013;14(1): 1–8. doi:10.1186/1129-2377-14-44
Gildir S, Tüzün EH, Eroğlu G, et al. A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache. Medicine. 2019;98(8): e14520. doi:10.1097/MD.0000000000014520
Saylor D, Steiner TJ. The Global Burden of Headache. Seminars in Neurology. 2018;38(2): 182–190. doi:10.1055/s-0038-1646946
