3. tension type headache.ppt

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TENSION TYPE

HEADACHE

Dr. Khairul P. Surbakti Sp.S

Departemen NeurologiFK S!"SP H. ADA# #A$IK#EDAN



TENSION TYPE HEADACHE

Defnition: An epi%o&i' or 'hroni' hea&a'he&ue to

%u%taine& mu%'le 'ontra'tion

Up to (() o* +omen an& ,-) o* meneperien'e ten%ion/t0pe hea&a'he &uring their

li*etime

The +or& 1ten%ion1 implie% that thi% t0pe o*hea&a'he 'an be attribute& entirel0 to ten%ion or%tre%%2 +hi'h ma0 make people +ith thi% t0pe o*hea&a'he relu'tant to 'on%ult a ph0%i'ian.



International Headache Societydiagnostic criteria or tension-type

headache

Primary diagnosis1. Hea&a'he ha% at least t+o o* the *ollo+ing

'hara'teri%ti'%3 5ilateral pain Pre%%ure #il& to mo&erate pain No in'rea%e& pain +ith ph0%i'al eertion2. And no more than one o* the *ollo+ing3

Sen%iti6it0 to light Sen%iti6it0 to %oun&3. And neither o* the *ollo+ing73 Nau%ea 8omiting

. And &uration o* 9: minute% to ; &a0%



!l if i i



!lassifcation o "ension"ype Headache #IHS 2$$%

Ten%ion T0pe Hea&a'he<.= In*re>uent epi%o&i' ten%ion/t0pe hea&a'he

<.=.= In*re>uent epi%o&i' ten%ion/t0pe hea&a'hea%%o'iate& +ith peri'ranial ten&erne%%

<.=.< In*re>uent epi%o&i' ten%ion/t0pe hea&a'he nota%%o'iate& +ith peri'ranial ten&erne%%

<.< Fre>uent epi%o&i' ten%ion/t0pe hea&a'he

<.<.= Fre>uent epi%o&i' ten%ion/t0pe hea&a'he

a%%o'iate& +ith peri'ranial ten&erne%%

<.<.< Fre>uent epi%o&i' ten%ion/t0pe hea&a'he nota%%o'iate& +ith peri'ranial ten&erne%%



<.9 Chroni' ten%ion/t0pe hea&a'he

<.9.= Chroni' ten%ion/t0pe hea&a'hea%%o'iate& +ith peri'ranial ten&erne%%

<.9.< Chroni' ten%ion/t0pe hea&a'he nota%%o'iate& +ith peri'ranial ten&erne%%

<.? Probable ten%ion/t0pe hea&a'he

<.?.= Probable in*re>uent epi%o&i' ten%ion/

t0pe hea&a'he <.?.< Probable *re>uent epi%o&i' ten%ion/t0pe hea&a'he

<.?.9 Probable 'hroni' ten%ion/t0pehea&a'he



In*re>uent epi%o&i' ten%ion/t0pehea&a'he



Fre>uent epi%o&i' ten%ion/t0pehea&a'he



Chroni' ten%ion/t0pe

hea&a'he



Sub&i6i%ion &iagno%i%

1. Epi%o&i' @=B &a0%!mo or 'hroni' @=B&a0%!mo *or , mo2. A%%o'iate& +ith or not a%%o'iate& +ith'oei%ting peri'ranial mu%'le ten&erne%%77

7Chroni' ten%ion/t0pe hea&a'he ma0 in'lu&eone o* the%e %0mptom%.

77Diagno%e& b0 manual palpation orele'trom0ographi' %tu&ie%.

Adapted from Headache ClassicationCommittee of the International Headache

Society (2).



Potential trigger% o* ten%ion/t0pehea&a'he

Stre%% @eg2 *amil0 'ri%e%2 hea60

+orkloa&%2 unplea%ant +ork or %o'ial%ituation%

Change in %leep regimen @eg2 %hi*t +ork2

o6er%leeping

Certain *oo&% @eg2 'aeine2 al'ohol2'hee%e2

'ho'olate Ph0%i'al eertion



Potential trigger% o* ten%ion/t0pehea&a'he

En6ironmental *a'tor% @eg2 %un glare2 o&or%2%moke2 ambient noi%e2 uore%'ent lighting2%u%taine& po%ture% at 6i&eo terminal% or +hile

&ri6ing Female hormonal 'hange% @eg2 men%e%2

menopau%e2 pregnan'02 eogenou% hormoneu%e

#e&i'ation% /eg2 nitrate%2 %ele'ti6e %erotoninreuptake inhibitor%2 antih0perten%i6e%

O6eru%e o* hea&a'he me&i'ation @eg2 analge%i'an& 'aeine 'ombination%2 butalbital'ompoun&%2 opiate%2 ergot



Pathoph0%iologi' me'hani%m%

The 'au%e o* ten%ion/t0pe hea&a'he i%unkno+n2

#o%t re%ear'h ha% *o'u%e& on aperipheral me'hani%m pertaining to

peri'ranial mu%'le ten&erne%%2 thu%eplaining the pre6iou% term 1mu%'le

'ontra'tion hea&a'he.1




Another h0pothe%i%2 *a6ore& b0ph0%i'ian% +ho belie6e migraine an&

ten%ion/ t0pe hea&a'he are part o* a

'ontinuum o* the %ame un&erl0ing&i%or&er2 i% that ten%ion/t0pe hea&a'heha% a purel0 'entral me'hani%m an& thatmu%'le ten%ion i% an epiphenomenon




The 'au%e o* ten%ion/t0pe hea&a'he i% mo%t likel0multi*a'torial an& be%t &e%'ribe& b0 Ole%enG%6a%'ular/m0ogeni'/%upra%pinal mo&el

It i% the 'on6ergen'e o* multiple pain path+a0%//

6a%'ular2 m0ogeni'2 %upra%pinal2 or all o* the%e//that enter the 'au&ate nu'leu% o* thetrigemino6a%'ular %0%tem an&2 in 'ombination +ithother pre'ipitating *a'tor% in a pre&i%po%e& per%on2

&etermine +hether the hea&a'he a'ti6ationthre%hol& i% met

A geneti' pre&i%po%ition ha% been %ugge%te& b0%tu&ie% that *oun& a three*ol& in'rea%e& in'i&en'eo* 'hroni' ten%ion/t0pe hea&a'he in *amilie%



Dieren'e *rom migraine3

• On%et i% more gra&ual ma0 per%i%t *or&a0%2 +eek%2 month% or e6en 0r%.• $a'k% the per%i%tent throbbing >ualit0.• Not a%%o'iate& +ith nau%ea2 photophobia2phonophobia.•

Doe% not %eriou%l0 inter*ere +ith &ail0a'ti6itie%.

• Sleep i% u%uall0 un&i%turbe&.



&onpharmacologic approaches totreatment o tension-type headache

'eg(lation o liestyle#aintain regular %leep %'he&uleEat regular meal%2 A6oi& kno+n &ietar0 trigger%et regular aerobi' eer'i%e

)inimi*ation o emotional stressors

Plan ahea& an& a6oi& %tre%%*ul %ituation%Con%i&er in&i6i&ual or *amil0 p%0'hotherap0 +,oidance o en,ironmental precipitants

Jear %ungla%%e%A6oi& %moke2 %trong o&or%2 an& noi%0 area%

#aintain proper po%ture limit %u%taine& po%ition% Physical therapy techni(es

Heat2 i'e2 ultra%oun&2 TENS #a%%age or 'er6i'al tra'tion

Stret'hing an& %trengthening eer'i%e% *or 'er6i'al

mu%'ulature Trigger point %tret'hing2 'ompre%%ion2



+orti,e therapy Simple analge%i'% 3 A%pirin 2 A'etaminophen

Simple analge%i' 'ombination% +ith 'aeine 3A%pirin L

Caein2 A'etaminophen LCaein

NSAID 3 Naproen2 Ketopro*en2 Ibupro*en2Di'lo*ena'

Prophylactic therapy Tri'0'li' anti&epre%%ant% 3 Amitriptiline So&ium 6alproat

8enla*aine To iramate

Pharmacologic treatment o tension-type headache



C$STE" HEADACHE



S0non0m3

"ae&erM% %0n&rome2 Hi%tamine 'ephalalgia2"e& migraine2 paro0%mal no'turnal'ephalagia. Age <: to B: 0r%.

Se men are ae'te& ; to ( time% morethan +omen. The pain begin% +ithout +arning% rea'he% a 're%'en&o +ithin B minute%. Ea'h

atta'k la%t *or 9: min to < hour%. = 9 %hort/li6e& atta'k%!&a0 o6er a ? (+eek% perio&2 *ollo+e& b0 a pain *ree inter6althat a6erage one 0ear.

C$STE" HEADACHE



o Almo%t al+a0% the %ame orbit i% in6ol6e&&uring atta'k%.

o

The pain i% e'ru'iating in inten%it0 &eep2 non/u'tuating an& eplo%i6e in>ualit0.

o A%%o'iate& +ith / homolateral la'rimation2

re& e0e2 mio%i%2 li& pto%i%2 na%al %tune%% nau%ea.

o On%et i% no'turnal i% about B:) o* the'a%e% then pain u%uall0 a+aken% the

patient% +ithin < hour% o* *alling a%leep.



Pathoph0%iolog0

A neuro6a%'ular &i%or&er h0pothe%ie& to begenerate& in the CNS in pa'emaker or 'ir'&ianregion% o* the h0pothalami' gra0 matter

The trigeminal!'er6i'al nu'lear o6erlap i% al%o'entral to the pathogene%i%

A'ti6ation o* trigemino6a%'ular %0%tem @C"P*rom peripheral terminal% o* trigeminalno'i'epti6e neuron +hi'h %uppl0 'ephali'bloo& 6e%%el% un&erlie% %0mptom% o* 'lu%terhea&a'he



Diagno%ti' Criteria *or Clu%ter

Hea&a'he A. At lea%t Q6e atta'k% *ulQlling 'riteria 5 through D5. Se6ere unilateral orbital2 %upraorbital an&!or

temporal pain la%ting =B to =(: minute%@untreate&

C. Hea&a'he a%%o'iate& +ith at lea%t one o* the*ollo+ing %ign% on the pain %i&e3

D.D. Fre>uen'0 o* atta'k%3 one atta'k e6er0 otherFre>uen'0 o* atta'k%3 one atta'k e6er0 other

&a0 to&a0 to eight atta'k% per &a0 eight atta'k% per &a0

ConRun'ti6alConRun'ti6al

inRe'tioninRe'tion

$a'rimation$a'rimation Na%al 'onge%tionNa%al 'onge%tion

"hinorrhea"hinorrhea Forehea& an&Forehea& an&

*a'ial*a'ial

%+eating%+eating

#io%i%#io%i%

Pto%i%Pto%i%E0eli& e&emaE0eli& e&ema



Clu%ter hea&a'he

#ale

On%et =/<hour% a*ter

*allinga%leep

Stri'tl0unilateral

A6oi&re'umbentpo%ition



Clu%ter perio& u%uall0 la%tbet+een < +eek% an& 9 month%



Dieren'e *rom migraine

#ale pre&ominant. "api& e6olution. Non/throbbing. "h0thmi'it0. Flu%hing o* the %i&e o* the *a'e @pallor in 'a%e

o*

migraine. Temperature at the %i&e o* the pain @

temp. in

migraine. IOP @IOP in migraine.



Treatment3o Inhalation o* =::) O< ;$!mnt *or =: =Bminute%.o $o'al anae%ttheti' 3 =ml li&o'aine intrana%al

?) .o Dih0&roergotamine @DHE 3 :2B/=2B mg i.6o Sumatriptan %.'. , mgo In&ometha'in @re'tal %uppo abapentin or Topiramateo Opioi&% @re'tal2 Sta&ol na%al %pra0



Proph0lai%

/ 8erapamil =<:/=,: mg t.i.&

/ $ithium 9:: to =B:: mg!&a0./ #eth0%ergi&e ?/=: mg!&a0./ Di6alproi' %o&ium%/ Neurolepti' @Chlorpromaine

/ In&ometha'in 3 =B: mg!&a0/ Steroi&/ Opioi&

3. tension type headache.ppt

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