tension headache

緊張型頭痛

WordNet

1. (psychology) a state of mental or emotional strain or suspense; "he suffered from fatigue and emotional tension"; "stress is a vasoconstrictor" (同)tenseness, stress
2. the physical condition of being stretched or strained; "it places great tension on the leg muscles"; "he could feel the tenseness of her body" (同)tensity, tenseness, tautness
3. (physics) a stress that produces an elongation of an elastic physical body; "the direction of maximum tension moves asymptotically toward the direction of the shear"
4. a balance between and interplay of opposing elements or tendencies (especially in art or literature); "there is a tension created between narrative time and movie time"; "there is a tension between these approaches to understanding history"
5. the action of stretching something tight; "tension holds the belt in the pulleys"
6. pain in the head caused by dilation of cerebral arteries or muscle contractions or a reaction to drugs (同)head ache, cephalalgia

PrepTutorEJDIC

1. 〈U〉『ぴんと張ること』,伸長;ぴんと張った状態,張り / 〈U〉(精神的・感情的)『緊張』 / 〈C〉《複数形で》(一般に)『緊張状態(関係)』 / 〈U〉張力,引っ張る力 / 〈U〉起電力;電圧(voltage)
2. 『頭痛』 / 《話》悩みの種

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/12/13 01:49:07」(JST)

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[Wiki en表示]

Tension headache
Classification and external resources
Tension-type headaches can be aggravated by temporomandibular joint dysfunction.
ICD-10	G44.2
ICD-9	307.81, 339.1
DiseasesDB	12554
MedlinePlus	000797
eMedicine	article/1142908
MeSH	D018781

A tension headache (renamed a tension-type headache by the International Headache Society in 1988) is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population has chronic tension-type headaches.

Signs and symptoms

Tension-type headache pain is often described as a constant pressure, as if the head were being squeezed in a vice. The pain is frequently bilateral which means it is present on both sides of the head at once. Tension-type headache pain is typically mild to moderate, but may be severe.

Frequency and duration

Tension-type headaches can be episodic or chronic. Episodic tension-type headaches are defined as tension-type headaches occurring fewer than 15 days a month, whereas chronic tension headaches occur 15 days or more a month for at least 6 months. Tension-type headaches can last from minutes to days, months or even years, though a typical tension headache lasts 4–6 hours.

Cause

Various precipitating factors may cause TTH in susceptible individuals:

• Stress: usually occurs in the afternoon after long stressful work hours or after an exam
• Sleep deprivation
• Uncomfortable stressful position and/or bad posture
• Irregular meal time (hunger)
• Eyestrain

One half of patients with TTH identify stress or hunger as a precipitating factor.^{[citation needed]}

Tension headaches may be caused by muscle tension around the head and neck. One of the theories says that the main cause for tension type headaches and migraine is teeth clenching which causes a chronic contraction of the temporalis muscle.^{[citation needed]}

Another theory is that the pain may be caused by a malfunctioning pain filter which is located in the brain stem. The view is that the brain misinterprets information, for example from the temporal muscle or other muscles, and interprets this signal as pain. One of the main neurotransmitters which is probably involved is serotonin. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as amitriptyline. However, the analgesic effect of amitriptyline in chronic tension-type headache is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved. Recent studies of nitric oxide (NO) mechanisms suggest that NO may play a key role in the pathophysiology of CTTH. The sensitization of pain pathways may be caused by or associated with activation of nitric oxide synthase (NOS) and the generation of NO. Patients with chronic tension-type headache have increased muscle and skin pain sensitivity, demonstrated by low mechanical, thermal and electrical pain thresholds. Hyperexcitability of central nociceptive neurons (in trigeminal spinal nucleus, thalamus, and cerebral cortex) is believed to be involved in the pathophysiology of chronic tension-type headache. Recent evidence for generalized increased pain sensitivity or hyperalgesia in CTTH strongly suggests that pain processing in the central nervous system is abnormal in this primary headache disorder. Moreover, a dysfunction in pain inhibitory systems may also play a role in the pathophysiology of chronic tension-type headache.

Prevention

Tricyclics have been found to be more effective than SSRIs but have greater side effects. Evidence is insufficient for the use of propranolol and muscle relaxants for prevention of tension headaches.

Treatment

Episodic tension-type headaches generally respond well to over-the-counter analgesics such as ibuprofen, paracetamol/acetaminophen, and aspirin. Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations like Syndol, Mersyndol and Percogesic, analgesic/barbiturate combinations such as Fiorinal). Frequent use of analgesics may, however, lead to medication overuse headache. The first-line treatment for chronic tension type headache is amitriptyline, whereas mirtazapine and venlafaxine are second-line treatment options. Other medication options include topiramate and sodium valproate (as prophylaxis). Biofeedback techniques may also help.

Botulinum toxin is a treatment trialled by some people with tension-type headache, though results are varied.^{[citation needed]}

Acupuncture

A 2009 Cochrane review concluded that acupuncture could be a valuable non-pharmacological option in patients with frequent episodic or chronic tension-type headaches.

Manual therapy

People with tension-type headache often use chiropractic, manual therapy, spinal manipulation, soft tissue therapy, and myofascial trigger point treatment. A 2006 systematic review found no rigorous evidence supporting manual therapies for tension headache. A 2005 structured review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine. A 2004 Cochrane review found that spinal manipulation may be effective for migraine and tension headache, and that spinal manipulation and neck exercises may be effective for cervicogenic headache. Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of spinal manipulation.

Prognosis

Tension headaches that do not occur as a symptom of another condition may be painful, but are not harmful. It is usually possible to receive relief through treatment. Tension headaches that occur as a symptom of another condition are usually relieved when the underlying condition is treated. Frequent use of pain medications in patients with tension-type headache may lead to the development of medication overuse headache or rebound headache.

References

External links

• American Council for Headache Education
• National Headache Foundation
• World Headache Alliance

UpToDate Contents

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• 1. 成人における緊張型頭痛：急性期治療 tension type headache in adults acute treatment
• 2. 成人における緊張型頭痛：病態生理、臨床的特徴、および診断 tension type headache in adults pathophysiology clinical features and diagnosis
• 3. 成人における緊張型頭痛：予防的治療 tension type headache in adults preventive treatment
• 4. 小児における緊張型頭痛 tension type headache in children
• 5. 慢性連日性頭痛の概要 overview of chronic daily headache

English Journal

• Behavioral management of the triggers of recurrent headache: A randomized controlled trial.

• Martin PR1, Reece J2, Callan M3, MacLeod C4, Kaur A3, Gregg K3, Goadsby PJ5.
• Behaviour research and therapy.Behav Res Ther.2014 Oct;61:1-11. doi: 10.1016/j.brat.2014.07.002. Epub 2014 Jul 16.
• This study was designed to evaluate the traditional advice to headache sufferers to avoid all triggers ('Avoidance'), and a novel approach to trigger management (Learning to Cope with Triggers - 'LCT') that included graduated exposure to selected triggers to promote desensitization. Individuals (84F
• PMID 25108482

• Self-reported neck pain is associated with migraine but not with tension-type headache in adolescents.

• Blaschek A1, Decke S2, Albers L2, Schroeder AS3, Lehmann S2, Straube A4, Landgraf MN3, Heinen F3, von Kries R2.
• Cephalalgia : an international journal of headache.Cephalalgia.2014 Oct;34(11):895-903. doi: 10.1177/0333102414523338. Epub 2014 Feb 19.
• AIM: The aim of the present analysis is to confirm or refute the association of neck pain to migraine or tension-type headache and to assess whether this association is independent of other risk factors for headache.METHODS: Secondary school students were invited to complete a questionnaire on heada
• PMID 24554618

• Treatment of PTSD and Chronic Daily Headache.

• Smitherman TA1, Black AK, Davis CN.
• Current treatment options in neurology.Curr Treat Options Neurol.2014 Oct;16(10):312. doi: 10.1007/s11940-014-0312-7.
• OPINION STATEMENT: Posttraumatic stress disorder (PTSD) is often comorbid with chronic migraine (CM) and chronic tension-type headache (CTTH). Trauma-focused cognitive behavioral psychotherapies, selective serotonin reuptake inhibitors (SSRIs), and venlafaxine have demonstrated efficacy in the treat
• PMID 25129572

Japanese Journal

• 頭痛への漢方治療 (特集 慢性痛患者への漢方医療)

• 麻酔 = The Japanese journal of anesthesiology : 日本麻酔科学会準機関誌 66(7), 700-707, 2017-07
• NAID 40021257595

• 緊張型頭痛 (頭痛診療 : 基礎・臨床の最新情報) -- (頭痛の診断と治療)

• 日本臨床 = Japanese journal of clinical medicine 75(6), 883-888, 2017-06
• NAID 40021223138

• 頭痛の治療学総論 (頭痛診療 : 基礎・臨床の最新情報)

• 日本臨床 = Japanese journal of clinical medicine 75(6), 841-848, 2017-06
• NAID 40021222975

Related Links

• Tension headache: MedlinePlus Medical Encyclopedia

The goal is to treat your headache symptoms right away, and to prevent headaches by avoiding or changing your triggers. A key step in doing this involves learning to manage your tension headaches at home by: Keeping ...

• Tension Headaches - WebMD - Better information. Better health.

Tension headaches are the most common type of headaches among adults. They are commonly referred to as stress headaches. A tension headache may appear periodically ("episodic," less than 15 days per month) or ...

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リンク元

「緊張型頭痛」

「緊張型頭痛」

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英

tension-type headache, tension headache

同

筋収縮性頭痛、筋緊張性頭痛、緊張性頭痛、筋緊張型頭痛、muscle contraction headache MCH

関

頭痛

[show details]

緊張型頭痛 : 約 426,000 件
筋収縮性頭痛 : 約 10,400 件
筋緊張性頭痛 : 約 30,000 件
緊張性頭痛 : 約 170,000 件
筋緊張型頭痛 : 約 166,000 件

頻度

• 慢性頭痛の中で最も多い
• 夕方に認められる頭痛に多い。

家族歴

• ほとんどない(少ない)

男女比

• なし(やや女性が多いか)

持続時間

• 長期間にわたることがある。

性状

• 鈍痛、軽度から中等度
• 頭を締めつけられる、または押さえつけられる感じ

• 1. 深部の絞めつけられるような感じ(絞扼感)
• 2. 帽子をかぶったような感じ(被帽感)
• 3. あるいは頭頂部の圧迫感

部位

• 頭部全般(後頭部に強い)
• 両側性が多いが、片側性もありうる(1/3を占める)

日常動作の影響

• 臥床することはない

随伴症状

• 後頭部～項部の筋肉に凝り、持続的な収縮を伴う(ことがある)。後頭筋・側頭筋・項筋群に限局性の硬結や圧痛　←　いわゆる肩が凝る
• 悪心・嘔吐はなし
• 光過敏・音過敏はあってもいずれか1つ

増悪因子

• (日常生活動作で増悪しない)

誘因

• 運動不足、一定姿勢の保持(筋性ストレス、うつむき姿勢)、精神的ストレス・心理社会的ストレス・心的緊張、抑うつ、眼精疲労、頚椎異常、咬合不全、頭痛薬の過剰摂取

診断基準

国際頭痛分類第2版における緊張型頭痛の診断基準

• A 〈2.1　稀発反復性緊張型頭痛は、1ヵ月に1日未満の頻度で生じる頭痛〉

• 〈2.2　頻発反復性緊張型頭痛は、1ヵ月に1日以上、15日未満の頻度生じる頭痛〉
• 〈2.3　慢性緊張型頭痛は、1ヵ月に15日以上の頻度生じる頭痛〉

• B 頭痛は30分～7日間持続する
• C 頭痛は以下の特徴の少なくとも2項目を満たす

• 1 両側性
• 2 性状は圧迫感または締め付け感（非拍動性）
• 3 強さは軽度～中等度
• 4 歩行や階段の昇降のような日常的な動作により増悪しない

• D 以下の両方を満たす

• 1 悪心や嘔吐はない（食欲不振を伴うことはある）
• 2 光過敏や音過敏はあってもどちらか一方のみ

• E その他の疾患によらない

緊張型頭痛の診断基準をひとつだけ満たさず、かつ片頭痛でないものは、〈2.4　緊張型頭痛の疑い〉に分類されます。

治療

• 方針：原因となるストレスの除去、対症療法。

方法

• 生活習慣の改善
• 運動療法　　運動のほか休養やマッサージもありうる
• 心理療法　　ストレスや不安の除去を促す
• 薬物療法

• NSAID
• NSAID+カフェイン
• 抗うつ薬
• 筋弛緩薬　　筋のストレスを除去
• 抗不安薬

参考

• 慢性頭痛　日本頭痛学会編／一般・GL（06年）／ガイドライン　緊張型頭痛はどのように分類し、診断されるのですか

http://minds.jcqhc.or.jp/stc/0025/3/0025_G0000155_0037.html