HEAD PAIN - TENSION TYPE HEADACHE

HEAD PAIN - TENSION TYPE HEADACHE

DEFINITION OF HEAD PAIN
is pain or discomfort in the upper part of the head of the orbital region to the occiput area.Headaches can be a primary or secondary complaint

• Primary = primary headache is a diagnosis, not due to another disease
• Secondary = headache is a symptom of other diseases because of the bandwagon → hypertension, sinus inflammation, premenstrual disorders, etc.

I. Primary headache

1. Migraine
2. Tension type Headache
3. Sefalalgia cluster headache and other trigeminal-autonomic
4. Other primary headache

II. Secondary headache

1. Headache associated with head trauma and / or neck
2. Headache related to cranial or cervical vascular disorder
3. Headache associated with non-vascular intracranial disorder
4. Headache associated with substances or their withdrawal
5. Headache associated with infection
6. Headaches associated with homeostasis disorders
7. Vascular headache or pain associated with abnormal cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or strukturfacial or other cranial.
8. Headache associated with psychiatric disorders

III. Cranial neuralgia, central or primary facial pain and other 
       headaches

1. Cranial neuralgias and central causes of facial pain
2. Other headache, cranial neuralgia, central or primary facial pain

TENSION TYPE HEADACHE (TTH) 
Tension Type Headache (TTH) is a pain in the, such as heavy pressure or tightly bound, generally bilateral arise initially episodic and tied with stress but then almost every day appear in the chronic form, without any more obvious psychological association. 
TTH According to the International Classification of Headache Society (IHS)

• Frequent episodic tension-type headache
• Infrequent episodic tension-type headache
• Chronic Tension Headache
• Probable Tension Type Headache

TENSION TYPE HEADACHE (TTH)

• Most often occurs,
• Prevalence of ♂: ♀ = 69%: 88%
• Generally occurs bilaterally.
• that a constant dull pain, or a feeling of pressing, not bad on the neck, temples, forehead, around the head, neck stiffness
• It is rare in children, most commonly between the ages of 20-40 years
• It episodic or chronic.

TRIGGER ON TTH.

1. Stress
2. Depression and anxiety
3. Lack of sleep or changes in sleep routine
4. Skipping meals
5. One position
6. Working in a fixed position for a long time
7. Physical activity is less
8. Hormonal: usually changes during menstruation, pregnancy or menopause
9. The use of drugs: antihypertensives, anti depression
10. Excessive use of drugs

ETIOLOGY

• Oromandibular dysfunction
• Psychological stress
• Anxiety
• Depression
• Headache as a delusion
• Stress muscle
• Excess drinking reliever tension-type headache
• One of the abnormalities of the 5-11 group according to IHS classification

Episodic TTH Clinical Diagnosis
A. Head pain ≥ 10 times, a long attack 1-15 days / <1, meets
     the criteria B-D
B. The duration ranges from 30 minutes - 7 days.
C. His headache had ≥ 2 of the signs below:
    1. location bilateral
    2. Pressing / binding (not pulsed)
    3. Pain with light intensity - moderate
    4. Not gain weight with regular physical activity
D. Not available:
    1. Nausea or vomiting
    2. Fotofobi / fonofobi simultaneously
E. Not associated with other abnormalities

Clinical Presentation of Chronic TTH

• Suffering from headaches with an average frequency of 15 days / month (or 180 days / year) for> 3 months / year BD criteria
• Headache lasts a few hours / continuous
• Have a sign of ≈ Episodic TTH
• Not associated with other diseases

Pain Sensitive Network :
1. periosteum vertebrae
2. Intervertebral disc annulus fibrosus
3. Synovial joints between the vertebrae
4. Muscles and tendons
5. blood vessel
6. spinal nerves
7. peripheral nerve

PATHOPHYSIOLOGY TTH

TOOLS MEASURING PAIN

 

VAS

HANDLING TTH
General treatment of headache include :
• Lifestyle nice and orderly.
• Avoid headache triggers
• Sport and biofeedback
• Treatment medikamentosa with a positive interaction between
  doctor and patient.

MANAGEMENT TTH

 
Acute attacks
In the acute attack → should not be more than 2 days / week

Analgesics :
- Aspirin 1000 mg / day,
   Acetaminophen 1000 mg / day,
- NSAIDs :
   • Naproxen 660-750 mg / day
   • Ketoprofen 25-50 mg / day
   • Tolfenamic 200 ^ 400 mg / day
   • mefenamic acid,
   • Fenoprofen, ibuprofen 800 mg / day, diclofenac  
     50-100 mg / day

Analgetik :
for long periods can cause gastrointestinal irritation, kidney disease and
liver, impaired platelet function.

• Caffeine (analgesic adjuvant) 65 mg.
• Combination: 325 aspirin, acetaminophen 40 mg of caffeine.

PROCEDURES Non-pharmacological Therapies

• Perform stretching exercises neck or shoulder muscles at least 20-30 minutes
• Changes in sleep position
• Breathing with the diaphragm or other muscles relaxation method
• Adjustment of the work or home environment:
• proper lighting for reading, working, using the computer, or while watching television
• Avoid continuous exposure to loud sounds and noisy
• Avoid low temperature during sleep at night

RED FLAG HEAD PAIN

• Sudden headache
• Anticoagulants usage
• History of head trauma a few months ago
• Heat
• There is a prominent pain and stiffness in the neck
• Impairment of consciousness
• Focal neurological deficit