Naprienko M.V., Filatova E.G., Smekalkina L.V., Makarov S.A. Tension headache. Let us get a second look. Consilium Medicum. 2019; 21 (2): 79–85. DOI: 10.26442/20751753.2019.2.190281
Naprienko M.V., Filatova E.G., Smekalkina L.V., Makarov S.A. Tension headache. Let us get a second look. Consilium Medicum. 2019; 21 (2): 79–85. DOI: 10.26442/20751753.2019.2.190281
Обоснование. Головная боль напряжения (ГБН) является самым частым видом головной боли. Степень дезадаптации и социально-экономический ущерб, связанные с ГБН, больше, чем при мигрени. Диагностика и лечение ГБН является сложной задачей для амбулаторной практики. Цель. Детально проанализировать патогенетические механизмы, факторы хронификации, а также обобщить терапевтические подходы к лечению ГБН.
Материалы и методы. Для написания обзора систематезированы материал российских и зарубежных публикаций за последние 20 лет (PubMed, eLIBRARY и пр.), а также клинические рекомендации по диагностике и ведению пациентов с ГБН. Результаты. По данным популяционного исследования, проведенного в 2009–2011 гг. в России, распространенность ГБН за один год составила 30,8%. ГБН подразделяют на нечастую, частую и хроническую. Кроме того, различают эпизодическую и хроническую ГБН «с напряжением» и «без напряжения» перикраниальных мышц путем их пальпации. Исследования, проведенные в последние годы, подтвердили нейробиологическую природу ГБН. В ее происхождении принимают участие как периферические, так и центральные ноцицептивные механизмы. Основными факторами риска ГБН являются неспособность к психологическому и мышечному расслаблению и недостаточный ночной сон. Самые частые провоцирующие факторы – эмоциональный стресс и позное напряжение. Детально проанализированы рандомизированные контролируемые исследования, посвященные купированию эпизодов головной боли, продемонстрированы наиболее часто используемые препараты, среди которых важное место занимает кетопрофен (Кетонал®). Показанием к назначению профилактического лечения ГБН является ее хронический или частый эпизодический характер. Антидепрессанты – препараты 1-го выбора для лечения хронической ГБН, таким препаратом считается амитриптилин, меньшей эффективностью обладают миртазапин и венлафаксин. К препаратам 3-го выбора относятся другие три- и тетрацикличекие антидепрессанты, кломипрамин, мапротилин и миансерин. Обсуждаются эффективность миорелаксанта тизанидина, дозировки и длительность применения при лечении ГБН, возможности как монотерапии, так и комбинированного с антидепрессантами назначения. Среди нелекарственных методов наиболее эффективными являются биологическая обратная связь и когнитивно-поведенческая терапия. Заключение. Наиболее эффективной в лечении ГБН остается комбинированная терапия, включающая наряду с фармакотерапией нелекарственные методы.
Introduction. Tension headache (TH) is the most frequent type of headache. The overall amounts of patients’ disadaptation and social and economic damage caused by TH are more significant than ones caused by migraine. TH diagnostics and treatment are a challenge in outpatient conditions. Aim. To analyze in detail pathogenic mechanisms and chronification factors, and to generalize therapeutic approaches to TH treatment. Materials and methods. Materials from Russian and foreign publications for the last 20 years (PubMed, eLIBRARY and others) as well as clinical guidelines on TH diagnostics and treatment were systematized.
Results. According to the results of a population study conducted in Russia in 2009–2011, TH prevalence rate was 30.8% over one year. TH is subdivided into infrequent, frequent and chronic headache. Apart from that, episodic and chronic TH with and without “tension” of pericranial muscles determined by palpation are distinguished. The studies conducted in recent years confirmed neurobiological genesis of TH. Peripheral as well as central mechanisms are involved in its genesis. The main risk factors of TH development include inability of psychological and muscular relaxation and insufficient nocturnal sleep. Emotional stress and pose strain are the most frequent predisposing factors. We thoroughly analyzed data of randomized controlled studies of rapid relief of TH symptoms and identified the most frequently used medications among which ketoprofen (Ketonal®) occupies an important place. Chronic or frequent episodic TH is indication for TH prevention therapy prescription. Antidepressants such as amitriptyline are considered the first choice medications for chronic TH treatment, mirtazapine and venlafaxine are of lower effectiveness. The third choice therapy includes other tricyclic and tetracyclic antidepressants, clomipramine, maprotiline, and mianserine. Effectiveness of muscle relaxant tizanidine use, dosage and duration of its use in TH treatment, possibilities of monotherapy and combination with antidepressants are discussed. Among non-pharmacological treatment methods biofeedback and cognitive behavior therapy are considered the most effective ones. Conclusion. Combination therapy, including non-pharmacological treatment methods along with pharmacotherapy, remains the most effective method of TH treatment.
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________________________________________________
1. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA 1998; 279 (5): 381–3.
2. Ayzenberg I, Katsarava Z, Sborowski A et al. Headache-attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed. Eur J Neurol 2014; 21 (5): 758–65. DOI: 10.1111/ene.12380
3. Lyngberg AC, Rasmussen BK, Jorgensen T et al. Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. Eur J Epidemiol 2005; 20: 243–9.
4. Stovner L, Hagen K, Jensen R et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007; 27: 193–210.
5. Karen W, Judith B, Bull PN, Poulton R. Tension type headache: A life-course review. J Headache Pain Management 2015; 1 (1): 1–9.
6. Headache Classification Subcommittee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 2013; 33 (9): 629–808.
7. Voznesenskaia T.G., Vein A.M. Golovnaia bol' napriazheniia. Conslium Medicum 1999; 1 (2): 65–8 (in Russian).
8. Rosen NL. Psychological issues in the evaluation and treatment of tension-type headache. Curr Pain Headache Rep 2012; 16 (6): 545–53.
9. Kaniecki RG. Tension type headache. Continuum Lifelong Learning Neurol 2012; 18 (4): 823–34.
10. Bendtsen L. Central sensitization in tension-type headache possible pathophysiological mechanisms. Cephalalgia 2000; 20 (5): 486–508.
11. Osipova V.V. Disfunktsiia perikranial'nykh myshts pri pervichnoi golovnoi boli i ee korrektsiia. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2010; 4: 29–35 (in Russian).
12. Fernandez-de-las-Penas C. Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache. J Headache Pain 2011; 12 (1): 35–43. DOI: 10.1007/s10194-011-0316-6
13. Akhmadeeva L.R., Azimova Iu.E., Karakulova Iu.V. et al. Klinicheskie rekomendatsii po diagnostike i lecheniiu golovnoi boli napriazheniia. RMZh. 2016; 7: 411–9 (in Russian).
14. Stainer T.Dzh. et al. Evropeiskie printsipy vedeniia patsientov s naibolee rasprostranennymi formami golovnoi boli v obshchei praktike. Prakticheskoe rukovodstvo dlia vrachei. Moscow: OGGI. Reklamnaia produktsiia, 2010 (in Russian).
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17. Kozub O.V., Glembotskaia G.T. Sotsiologicheskaia otsenka indikatorov kachestva farmatsevticheskoi pomoshchi patsientam s golovnoi bol'iu. Farmatsiia. 2012; 2: 30–2 (in Russian).
18. Sarzi-Puttini P, Atzeni F, Lanata L et al. Pain and ketoprofen: what is its role in clinical practice? Reumatismo 2010; 62 (3): 172–88.
19. Gascel H, Derry S, Wiffen PJ, Moore RA. Single dose oral ketoprofen or dexketoprofen for acute postoperative pain in adults (Review). Cochrane Database Syst Rev 2017. Issue 5. Art. No.: CD007355. DOI: 10.1002/14651858.CD007355.pub3
20. Pikovskii V.Iu., Kulik A.I., Sil'vestrov V.D. et al. Primenenie nesteroidnogo protivovospalitel'nogo preparata Ketonal (Ketoprofen) v usloviiakh dogospital'nogo etapa. Meditsina neotlozhnykh sostoianii. 2006; 3 (4): 71–2 (in Russian).
21. Strachunskaia E.Ia., Iur'eva Iu.V. Klinicheskoe obosnovanie primeneniia ketoprofena v nevrologii dlia kupirovaniia bolevogo sindroma. Farmateka. 2003; 9: 8–12 (in Russian).
22. Kirienko P.A. Ispol'zovanie ketoprofena v klinicheskoi praktike. Vestn. intensivnoi terapii. 2006; 3: 45–9 (in Russian).
23. Lazebnik L.B., Drozdov V.N., Kolomiets E.V. Sravnitel'naia effektivnost' i bezopasnost' primeneniia ketoprofena, lornoksikama, nimesulida i tselekoksiba u bol'nykh osteoartrozom. Rus. med. zhurn. 2004; 12 (14): 844–7 (in Russian).
24. Danilov A.B. Ketonal® DUO v lechenii bolevogo sindroma. Effektivnaia farmakoterapiia. Nevrologiia i psikhiatriia. 2013; 1: 8–11 (in Russian).
25. Barden J, Derry S, McQuay HJ, Moore A. Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults. Cochrane Database Syst Rev 2009; 4: CD007355.
26. Pchelintsev M.V. "Tri kita" preparata Ketonal (ketoprofen): Manage pain (Upravliai bol'iu). 2016; 1 (in Russian).
27. Dib M, Massiou H, Weber M et al. Efficacy of oral ketoprofen in acute migraine: a double-blind randomized clinical trial. Neurology 2002; 58 (11): 1660–5.
28. Karabetsos A, Karachalios G, Bourlinou P et al. Ketoprofen versus paracetamol in the treatment of acute migraine. Headache 1997; 37 (1): 12–4.
29. Bendtsen L, Birk S, Kasch H et al. Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 2nd Edition, 2012. J Headache Pain 2012; 13 (Suppl. 1): 3.
30. Mastic J, Fasouli S, Novotn I. Ketoprofen in the treatment of tension-type headache and transformed migraine. Bolest 2003; 6 (4): 233–6.
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1 Клиника головной боли и вегетативных расстройств им. акад. Александра Вейна, Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*eg-filatova@mail.ru
________________________________________________
Margarita V. Naprienko1,2, Elena G. Filatova*1,2, Larisa V. Smekalkina2, Sergei A. Makarov2
1 Alexandr Wayne Clinic of Headache and Autonomic Disorders, Moscow, Russia;
2 I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
*eg-filatova@mail.ru