Tension Type HA Flashcards
Describe TTH pathology
Myofascial mechanism
- incr tenderness
- incr hardness
- local inflammation
- local ischemia
Autonomic nervous system dysfunction
Central mechanism (chronic TTH)
- Dysfunction in descending pain modulation
TTH triggers include:
- stress, anxiety
- depression
- sleep deprivation (possibly due to autonomic nervous system dysfunction)
- poor posture: head held in one position for a long time (e.g., neck flexion, head, facial)
- alcohol (withdrawal)
- caffeine (withdrawal - cause vasodilation)
- cold/flu/sinus infections
- dehydration
- hunger
- noise exposure
- smoking (nicotine and other chemicals can stimulate pain sensitive nerves)
*Modifiable risk factors
Risk factors for TTH
- females > males
- having depression/anxiety
- insomnia or difficulty getting to sleep/staying awake
- temporomandibular joint (TMJ) disorder
- vit deficiencies (vit b12, vit d)
What questions to ask to rule out secondary headache?
- Fever?
- Other symptoms - weakness?
- Headache frequency and quality?
- Precipitated by exercise?
- Precipitated by sneezing or coughing?
- Any recent injury to the head (post-trauma)?
- Painkiller use? - how much was used over how long?
Clinical presentation
- no prodrome and aura
- bilateral
- frontal, around eyes
- nuchal-occipital (back of neck)
- constant pain with gradual onset
- non-pulsatile, tightness, pressure, “band like”
- mild-mod intensity
- pericranial or cervical muscles tenderness
Duration: 30min - 7 days
*May be less in the morning, worse at night (think sleep deprivation as a trigger, think HA in insomnia pts)
*Does not worsen with activity, may improve with rest
Other features with TTH
- difficulty concentrating (pain, nuisance)
- stiff or tight muscles in the neck, front, and/or back of head (tenderness when touched/palpated)
- reduced appetite
- may see sensitivity to light OR sound (NOT both)
- no nausea/vomiting/aura (*may have mild nausea if chronic)
Types of TTH
- Infrequent episodic TTH
- Frequent episodic TTH
- Chronic TTH
Infrequent episodic TTH
At least 10 headaches, <1 episode per month, overall <12 per year
Duration: 30min - 7 days
Frequent episodic TTH
At least 10 headaches, 1-14 episode per month, for >3month, overall >= 12 per year / <180 per year
Duration: 30min - 7 days
Chronic TTH
> =15 headaches per month, for >3month, >= 180 per year
Duration: hours to days, or unremitting
May be more a/w vit deficiencities (vit B12, vit D)
Diagnostic criteria for episodic TTH
- At least two of the following:
- bilateral
- non-pulsatile, tightening/pressing
- mild-mod
- not worse with exertion
- No N/V and no more than one photophobia or phonophobia
- Not accounted for by another ICHD-3 diagnosis
Diagnostic criteria for chronic TTH
- At least two of the following:
- bilateral
- non-pulsatile, tightening/pressing
- mild-mod
- nor worse with exertion
- No more than one of photophobia/phonophobia/mild nausea, and neither moderate nor severe N/V
- Not accounted for by another ICHD-3 diagnosis
Goal of treatment of TTH
Pain relieve; prevent progression to chronic TTH
Patient education on TTH
- identify triggers and avoid them (e.g., stress management, sleep hygiene, mindful posture, prevent med overuse with painkillers)
- keep a headache diary (number and frequency of HA days, severity of symptoms, med use, identify other triggers)
Non-pharmacological treatment of TTH
- Self-limiting, rest
- Cognitive behavioral therapy (CBT), biofeedback, relaxation
- Physical and/or occupational therapy
- Lifestyle modification (include sleep hygiene)
