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Tension headache: causes and pathogenesis
Last reviewed: 23.04.2024
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Provoking factors of tension headache
The most important provoking factor of a tension headache attack is emotional stress (acute - with episodic, chronic - with chronic tension headache). When distracting attention or positive emotions, the pain may weaken or completely disappear, but then return again.
Another provoking factor is the so-called muscular factor: postural tension (prolonged forced position of the neck and head during work at the table, behind the wheel of the car), etc. It must be emphasized that emotional stress itself is a factor that causes and supports dysfunction of pericranial muscles.
Pathogenesis of tension headache
Although initially the tension headache was considered as predominantly a psychogenic disorder, the studies conducted in recent years have confirmed its neurobiological nature. It is assumed that both peripheral and central nociceptive mechanisms participate in the origin of the tension headache. In the pathogenesis of chronic tension headache, the leading role is assigned to the hypersensitivity (sensitization) of pain structures and insufficient function of the descending braking distances of the brainstem.
Classification of a tension headache
In MKGB-2, the tension headache is divided into episodic, arising not more often than 15 days during 1 month (or less than 180 days during the year), and chronic - more than 15 days per month (or more than 180 days during the year), and episodic the tension headache is divided into frequent and infrequent. On average, according to European data, episodic tension headache occurs in 50-60% of the population, chronic tension headache - in 3-5%. More often the doctor w has to deal with two varieties: frequent episodic and chronic tension headache. In addition, both forms are subdivided (depending on the presence or absence of muscle dysfunction) on the subtypes "with tension" and "without tension of pericranial muscles".
2. Headache of tension (MKGB-2, 2004)
- 2.1. Infrequent episodic tension headache.
- 2.1.1. Infrequent episodic tension headache, combined with the tension (soreness) of pericranial muscles.
- 2.1.2. Infrequent episodic tension headache, not combined with the tension of pericranial muscles.
- 2.2. Frequent episodic tension headache.
- 2.2.1. Frequent episodic tension headache, combined with the tension of pericranial muscles.
- 2.2.2. Frequent episodic tension headache, not combined with the tension of pericranial muscles.
- 2.3. Chronic tension headache.
- 2.3.1. Chronic tension headache, combined with the tension of pericranial muscles.
- 2.3.2. Chronic tension headache, not combined with the tension of pericranial muscles.
- 2.4. Possible tension headache.
- 2.4.1. Possible infrequent episodic tension headache.
- 2.4.2. Possible frequent episodic tension headache.
- 2.4.3. Possible chronic tension headache.
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