Хроническая головная боль напряжения: стратегия диагностики, поиск терапии

Азимова Ю.Э., Амелин А.В., Скоробогатых К.В. и др. Хроническая головная боль напряжения: стратегия диагностики, поиск терапии. Неврология и Ревматология (Прил. к журн. Consilium Medicum). 2018; 2: 20–25. DOI: 10.26442/2414357X.2018.2.000024

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Azimova Yu.E., Amelin A.V., Skorobogatykh K.V. et al. Chronic tension headache: diagnostic strategy, search therapy. Neurology and Rheumatology (Suppl. Consilium Medicum). 2018; 2: 20–25. DOI: 10.26442/2414357X.2018.2.000024

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Аннотация

Хроническая головная боль напряжения (ХГБН) – форма первичной головной боли, возникающая чаще 15 дней в месяц на протяжении более
3 мес или более 180 дней в год, длится несколько часов или дней или постоянная. ХГБН должна сопровождаться по меньшей мере двумя из следующих симптомов: двусторонняя локализация; давящий, сжимающий, непульсирующий характер боли; легкая или умеренная интенсивность боли; не усиливается при обычной физической нагрузке (ходьба, подъем по лестнице). Необходимо наличие обоих симптомов из следующих: только фотофобия или фонофобия, или тошнота; отсутствуют выраженная тошнота и рвота. Периферическими звеньями патогенеза ХГБН являются:
1) минимальное асептическое воспаление в мышцах (выделение алгогенных веществ в периваскулярное пространство мышц) с последующей атрофией и трансформацией мышц; 2) длительная последующая ишемия мышцы; 3) растяжение и повреждение связок патологически сокращенной мышцей. В дальнейшем развивается центральная сенситизация. Выбор терапии ХГБН ограничен антидепрессантами, миорелаксантами. Представлены два случая ХГБН – с напряжением перикраниальной мускулатуры и без. В обоих случаях стандартная терапия ХГБН не давала должного результата (болевой синдром продолжал персистировать). Пациентам по другим показаниям (тревога, диссомния) был назначен бензодиазепин – Феназепам (0,5 мг/сут), с помощью которого удалось купировать болевой синдром.

Ключевые слова: хроническая головная боль напряжения, Феназепам.

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Chronic tension headache (CTH) is a form of primary headache that occurs 15 or more days per month for more than 3 months or 180 days per year and lasts several hours or days or constantly. CTH must be accompanied by at least two of the following symptoms: bilateral localization of pain; pain feels like pressure sensation and is non-pulsating; pain intensity is mild to moderate; pain does not increase with normal physical exertion (walking, climbing stairs). Both of the following symptoms must be present: only photophobia or phonophobia or nausea; no severe nausea and vomiting. Peripheral links of CTH pathogenesis include: 1) minimal aseptic inflammation in muscles (a release of algogenic substances into muscles perivascular space) resulting in muscle atrophy and transformation; 2) prolonged subsequent muscle ischemia; 3) ligaments sprain and damage due to pathologically contracted muscle. Further central sensitization develops. Treatment of CTH is limited to antidepressants and muscle relaxants. Two cases are presented – with and without pericranial musculature tension. In both cases standard therapy was not effective (pain remained persistent). For other indications (anxiety, dyssomnia) benzodiazepine – Phenazepam (0,5 mg/day) was prescribed to patients and this allowed to achieve pain relief.

Key words: chronic tension headache, Phenazepam.

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Список литературы

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4. Ashina M. Neurobiology of chronic tension-type headache. Cephalalgia 2004; 24: 61–172.
5. Basbaum AI, Fields HL. Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry. Ann Rev Neurosci 1984; 7: 309.
6. Bendtsen L, Evers S, Linde M et al. EFNS guideline on the treatment of tension-type headache – report of an EFNS task force. Eur J Neurol 2010; 17 (11): 1318–25.
7. Biyouki F, Laimi K, Rahati S et al. Morphology of muscular function in chronic tension-type headache: a pilot study. Acta Neurol Belg 2016; 116 (3): 317–24.
8. Bono F, Salvino D, Mazza MR et al. The influence of ictal cutaneous allodynia on the response to occipital transcutaneous electrical stimulation in chronic migraine and chronic tension-type headache: a randomized, sham-controlled study. Cephalalgia 2015; 35 (5): 389–98.
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11. Dorpat TL, Holmes TH. Mechanisms of skeletal muscle pain and fatigue. Arch Neurol Psychiatry 1955; 74: 628.
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13. Fernandez-de-las-Penas C, Ambite-Quesada S, Rivas-Martinez I et al. Genetic contribution of catechol-O-methyltransferase polymorphism (Val158Met) in children with chronic tension-type headache. Pediatr Res 2011; 70 (4): 395–9.
14. Fernandez-de-Las-Penas C, Bueno A, Ferrando J et al. Magnetic resonance imaging study of the morphometry of cervical extensor muscles in chronic tensiontype headache. Cephalalgia 2007; 27 (4): 355–62.
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18. Jay GW. Sympathetic aspects of myofascial pain. Pain Dig 1995; 5: 192–4.
19. Lomas EC, Maskell PD. Phenazepam: More information coming in from the cold. J Forensic Leg Med 2015; 36: 61–2.
20. Martin PR, Mathews AM. Tension headaches: psychophysiological investigation and treatment. J Psychosom Res 1978; 22: 389.
21. Mazzotta G, Sarchielli P, Gaggioli A et al. Study of pressure pain and cellular concentration of neurotransmitters related to nociception in episodic tension-type headache patients. Headache 1997; 37: 565.
22. Miller T. Retrospective cohort analysis of 48 chronic headache patients treated with botulinum toxin-type A (Botox) in a combination fixed injection site and follow-the-pain protocol [abstract]. Presented at the American Headache Society Meeting, June 21–23. Seattle, WA, 2002.
23. Palacios-Ceña M, Castaldo M, Wang K et al. Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Medicine (Baltimore) 2017; 96 (13): e6548.
24. Palacios-Ceña M, Fernández-Muñoz JJ, Castaldo M et al. The association of headache frequency with pain interference and the burden of disease is mediated by depression and sleep quality, but not anxiety, in chronic tension type headache. J Headache Pain 2017; 18 (1): 19.
25. Park JW, Kim JS, Lee HK et al. Serotonin transporter polymorphism and harm avoidance personality in chronic tensiontype headache. Headache 2004; 44 (10): 1005–9.
26. Philips C, Hunter MS. A psychophysiological investigation of tension headache. Headache 1982; 22: 173.
27. Riley TL. Muscle-contraction headache. Neurol Clin 1983; 1: 489.
28. Rodbard S. Pain associated with muscle contraction. Headache 1970; 10: 105.
29. Sakuta M. Significance of flexed posture and neck instability as a cause of chronic muscle contraction headache. Rinsho Shinkeigato 1990; 30: 254.
30. Schmidt-Wicke T, Leinishc E, Straube A et al. Gray matter decrease in patients with chronic tension-type headache. Neurology 2005; 65: 1483–6.
31. Speed WG. Muscle contraction headaches. In: Saper JR, ed. Headache Disorders. Boston: John Wright, 1983; p. 115.
32. Van Den Maagdenberg AM, Terwindt GM, Haan J et al. Genetics of Headaches. Handb Clin Neurol 2010; 97: 85–97.
33. Verhagen AP, Damen L, Berger MY et al. Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review. Fam Pract 2010; 27 (2): 151–65.
34. Wörz R, Lobisch M, Schwittmann B et al. Effectiveness of flupirtine in chronic tension headache. Results of a double-blind study versus placebo. Fortschr Med 1995; 113 (32): 463–8.
35. Yu S, Han X. Update of Chronic Tension-Type Headache. Curr Pain Headache Rep 2015; 19: 469.

________________________________________________

1. Amelin A.V., Tarasova S.V., Sokolov A.Iu. Antikonvul'santy pri lechenii khronicheskoi ezhednevnoi golovnoi boli. Bol'. 2007; 1: 13–8. [in Russian]
2. Etingof A.M. Fenazepam: sovremennyi vzgliad na effektivnost' i bezopasnost'. Farmateka. 2014; 18. [in Russian]
3. Anheyer D, Leach MJ, Klose P et al. Mindfulness-based stress reduction for treating chronic headache: A systematic review and meta-analysis. Cephalalgia 2018: 333102418781795.
4. Ashina M. Neurobiology of chronic tension-type headache. Cephalalgia 2004; 24: 61–172.
5. Basbaum AI, Fields HL. Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry. Ann Rev Neurosci 1984; 7: 309.
6. Bendtsen L, Evers S, Linde M et al. EFNS guideline on the treatment of tension-type headache – report of an EFNS task force. Eur J Neurol 2010; 17 (11): 1318–25.
7. Biyouki F, Laimi K, Rahati S et al. Morphology of muscular function in chronic tension-type headache: a pilot study. Acta Neurol Belg 2016; 116 (3): 317–24.
8. Bono F, Salvino D, Mazza MR et al. The influence of ictal cutaneous allodynia on the response to occipital transcutaneous electrical stimulation in chronic migraine and chronic tension-type headache: a randomized, sham-controlled study. Cephalalgia 2015; 35 (5): 389–98.
9. Buchgreitz L, Lyngberg AC, Bendtsen L, Jensen R. Increased pain sensitivity is not a risk factor but a consequence of frequent headache: a population-based follow-up study. Pain 2008; 137 (3): 623–30.
10. Castien R, Blankenstein A, van der Windt D et al. The working mechanism of manual therapy in participants with chronic tension-type headache. J Orthop Sports Phys Ther 2013; 43 (10): 693–9.
11. Dorpat TL, Holmes TH. Mechanisms of skeletal muscle pain and fatigue. Arch Neurol Psychiatry 1955; 74: 628.
12. Drake ME, Pakalnis A, Andrews JM, Bogner JF. Nocturnal sleep recording with cassette EEG in chronic headaches. Headache 1990; 30: 600.
13. Fernandez-de-las-Penas C, Ambite-Quesada S, Rivas-Martinez I et al. Genetic contribution of catechol-O-methyltransferase polymorphism (Val158Met) in children with chronic tension-type headache. Pediatr Res 2011; 70 (4): 395–9.
14. Fernandez-de-Las-Penas C, Bueno A, Ferrando J et al. Magnetic resonance imaging study of the morphometry of cervical extensor muscles in chronic tensiontype headache. Cephalalgia 2007; 27 (4): 355–62.
15. Goldenberg DL. Fibromyalgia and chronic fatigue syndrome: are they the same? J Musculoskel Med 1990; 7: 19.
16. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38 (1):
1–211.
17. Jay GW, Barkin RL. Primary Headache Disorders-Part 2: Tension-type headache and medication overuse headache. Dis Mon 2017; 63 (12): 342–67.
18. Jay GW. Sympathetic aspects of myofascial pain. Pain Dig 1995; 5: 192–4.
19. Lomas EC, Maskell PD. Phenazepam: More information coming in from the cold. J Forensic Leg Med 2015; 36: 61–2.
20. Martin PR, Mathews AM. Tension headaches: psychophysiological investigation and treatment. J Psychosom Res 1978; 22: 389.
21. Mazzotta G, Sarchielli P, Gaggioli A et al. Study of pressure pain and cellular concentration of neurotransmitters related to nociception in episodic tension-type headache patients. Headache 1997; 37: 565.
22. Miller T. Retrospective cohort analysis of 48 chronic headache patients treated with botulinum toxin-type A (Botox) in a combination fixed injection site and follow-the-pain protocol [abstract]. Presented at the American Headache Society Meeting, June 21–23. Seattle, WA, 2002.
23. Palacios-Ceña M, Castaldo M, Wang K et al. Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Medicine (Baltimore) 2017; 96 (13): e6548.
24. Palacios-Ceña M, Fernández-Muñoz JJ, Castaldo M et al. The association of headache frequency with pain interference and the burden of disease is mediated by depression and sleep quality, but not anxiety, in chronic tension type headache. J Headache Pain 2017; 18 (1): 19.
25. Park JW, Kim JS, Lee HK et al. Serotonin transporter polymorphism and harm avoidance personality in chronic tensiontype headache. Headache 2004; 44 (10): 1005–9.
26. Philips C, Hunter MS. A psychophysiological investigation of tension headache. Headache 1982; 22: 173.
27. Riley TL. Muscle-contraction headache. Neurol Clin 1983; 1: 489.
28. Rodbard S. Pain associated with muscle contraction. Headache 1970; 10: 105.
29. Sakuta M. Significance of flexed posture and neck instability as a cause of chronic muscle contraction headache. Rinsho Shinkeigato 1990; 30: 254.
30. Schmidt-Wicke T, Leinishc E, Straube A et al. Gray matter decrease in patients with chronic tension-type headache. Neurology 2005; 65: 1483–6.
31. Speed WG. Muscle contraction headaches. In: Saper JR, ed. Headache Disorders. Boston: John Wright, 1983; p. 115.
32. Van Den Maagdenberg AM, Terwindt GM, Haan J et al. Genetics of Headaches. Handb Clin Neurol 2010; 97: 85–97.
33. Verhagen AP, Damen L, Berger MY et al. Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review. Fam Pract 2010; 27 (2): 151–65.
34. Wörz R, Lobisch M, Schwittmann B et al. Effectiveness of flupirtine in chronic tension headache. Results of a double-blind study versus placebo. Fortschr Med 1995; 113 (32): 463–8.
35. Yu S, Han X. Update of Chronic Tension-Type Headache. Curr Pain Headache Rep 2015; 19: 469.

Авторы

Ю.Э.Азимова1,2, А.В.Амелин3, К.В.Скоробогатых1, Е.А.Климов4, К.А.Ищенко5

1. ООО «Университетская клиника головной боли». 121467, Россия, Москва, ул. Молодогвардейская, д. 2, корп. 1;
2. ФГБНУ «Научно-исследовательский институт общей патологии и патофизиологии». 125315, Россия, Москва, ул. Балтийская, д. 8;
3. ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П.Павлова» Минздрава России. 197022, Россия, Санкт-Петербург, ул. Льва Толстого, д. 6/8;
4. ФГБОУ ВО «Московский государственный университет им. М.В.Ломоносова». 119991, Россия, Москва, Ленинские горы, д. 1;
5. АО «Валента Фармацевтика». 121471, Россия, Москва, ул. Рябиновая, д. 26, стр. 10

*azimova.j@mail.ru

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Yu.E.Azimova1,2, A.V.Amelin3, K.V.Skorobogatykh1, E.A.Klimov4, K.A.Ishchenko5

1. University Clinic Headache. 121467, Russian Federation, Moscow, ul. Molodogvardeiskaia, d. 2, korp. 1;
2. Research Institute of General Pathology and Pathophysiology. 125315, Russian Federation, Moscow, ul. Baltiiskaia, d. 8;
3. I.P.Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation. 197022, Russian Federation, Saint Petersburg, ul. L'va Tolstogo, d. 6/8;
4. M.V.Lomonosov Moscow State University. 119991, Russian Federation, Moscow, Leninskie gory, d. 1;
5. Valenta Farmatsevtika. 121471, Russian Federation, Moscow, ul. Riabinovaia, d. 26, str. 10

*azimova.j@mail.ru

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