Головная боль напряжения: клиника, диагностика, лечение

Котова О.В., Беляев А.А., Акарачкова Е.С. Головная боль напряжения: клиника, диагностика, лечение. Consilium Medicum. 2020; 22 (9): 68–70. DOI: 10.26442/20751753.2020.9.200458

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Kotova O.V., Belyaev А.А., Akarachkova E.S. Tension headache: clinic, diagnosis, treatment. Consilium Medicum. 2020; 22 (9): 68–70. DOI: 10.26442/20751753.2020.9.200458

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Аннотация

Головная боль напряжения (ГБН) – это неврологическое расстройство, характеризующееся приступами легкой или умеренной головной боли с небольшим количеством сопутствующих симптомов. Распространенность ГБН у взрослых в течение жизни, по результатам 5 популяционных исследований, составляет 46% (диапазон 12–78%). Основная причина ГБН неизвестна. Диагноз ставится на основании анамнеза и обследования. Многие пациенты самостоятельно лечат острые приступы и обращаются за медицинской помощью, когда приступы становятся частыми или хроническими. В лечении ГБН рекомендуют поведенческую терапию, купирование болевых эпизодов и профилактическое лечение. Острые приступы ГБН обычно купируют простыми анальгетиками (парацетамол, ацетилсалициловая кислота) или нестероидными противовоспалительными препаратами [ибупрофен, кетопрофен, напроксен]. Ситуация с обезболиванием при ГБН изменилась при появлении быстродействующих форм нестероидных противовоспалительных препаратов, в частности ибупрофена, так как быстроабсорбирующиеся соли ибупрофена действуют достоверно быстрее, имеют более выраженный и пролонгированный анальгетический эффект.

Ключевые слова: головная боль напряжения, эпидемиология, клиника, диагностика, лечение, быстродействующие формы ибупрофена.

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Tension headache (TH) is a neurological disorder characterized by attacks of mild to moderate headache with few associated symptoms. According to the data of 5 population studies, TH lifetime prevalence in adults is 46% (range 12–78%). The underlying cause of TH is unknown. Diagnosis is based on history and examination. Many patients self-manage their acute attacks and seek medical care when attacks become frequent or chronic. Behavioral therapy, relief of pain episodes and preventive treatment are recommended for HT treatment. Acute attacks of TH are usually treated with simple analgesics (paracetamol, acetylsalicylic acid) or non-steroidal anti-inflammatory drugs [ibuprofen, ketoprofen, naproxen]. The situation with pain relief in TH has changed with the emergence of fast-acting forms of non-steroidal anti-inflammatory drugs, in particular ibuprofen, since rapidly absorbing salts of ibuprofen act significantly faster, have a more pronounced and prolonged analgesic effect.

Key words: tension headache, epidemiology, symptoms, diagnosis, treatment, fast-acting forms of ibuprofen.

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Список литературы

1. Stovener LJ, Hagen K, Jensen R et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007; 27: 193–210.
2. Laurell K, Larsson B, Eeg-Olofsson O. Prevalence of headache in Swedish schoolchildren, with a focus on tension-type headache. Cephalalgia 2004; 24: 380–8.
3. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA 1998; 279: 381–3.
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9. Jensen R, Fuglsang-Frederiksen A. Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population. Electroencephalogr Clin Neurophysiol 1994; 93: 175.
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19. Diamond S. Ibuprofen versus aspirin and placebo in the treatment of muscle contraction headache. Headache 1983; 23: 206–10.
20. Schachtel BP, Furey SA, Thoden WR. Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache. J Clin Pharmacol 1996; 36: 1120–5.
21. Nebe J, Heier M, Diener HC. Low-dose ibuprofen in self-medication of mild to moderate headache: a comparison with acetylsalicylic acid and placebo. Cephalalgia 1995; 15: 531–5.
22. Moore RA, Derry S, Straube S et al. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain. Pain 2014; 155 (1): 14–21.
23. Packman B, Packman E, Doyle G. et al. Solubilized ibuprofen: evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache. Headache 2000; 40: 561–7.
24. 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: 1318.
25. Steiner TJ, Lange R, Voelker M. Aspirin in episodic tension-type headache: placebo-controlled dose-ranging comparison with paracetamol. Cephalalgia 2003; 23: 59–66.
26. Diener HC, Pfaffenrath V, Pageler L et al. The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Cephalalgia 2005; 25: 776–87.
27. Diamond S, Freitag FG. The use of ibuprofen plus caffeine to treat tension-type headache. Curr Pain Headache Rep 2001; 5: 472–8.
28. Scher AI, Stewart WF, Ricci JA, Lipton RB. Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 2003; 106: 81–9.
29. Bendtsen L, Jensen R. Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia 2000; 20: 603–10.
30. Bendtsen L. Central and peripheral sensitization in tension-type headache. Curr Pain Headache Rep 2003; 7 (6): 460–5.
31. Bettucci D, Testa L, Calzoni S et al. Combination of tizanidine and amitriptyline in the prophylaxis of chronic tension-type headache: evaluation of efficacy and impact on quality of life. J Headache Pain 2006; 7: 34–6.
32. Scripter C. Headache: Tension-Type Headache. FP Essent 2018; 473: 17–20.
33. Stetter F, Kupper S. Autogenic training: a meta-analysis of clinical outcome studies. Appl Psychophysiol Biofeedback 2002; 27 (1): 45–98.
34. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML et al. Are manual therapies effective in reducing pain from tension-type headache? A systematic review. Clin J Pain 2006; 22: 278–85.
35. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R. Prognosis of migraine and tension-type headache: a population-based follow-up study. Neurology 2005; 65: 580–5.

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1. Stovener LJ, Hagen K, Jensen R et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007; 27: 193–210.
2. Laurell K, Larsson B, Eeg-Olofsson O. Prevalence of headache in Swedish schoolchildren, with a focus on tension-type headache. Cephalalgia 2004; 24: 380–8.
3. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA 1998; 279: 381–3.
4. Scher AI, Stewart WF, Liberman J, Lipton RB. Prevalence of frequent headache in a population sample. Headache 1998; 38: 497–506.
5. Schwartz BS, Stewart WF, Lipton RB. Lost workdays and decreased work effectiveness associated with headache in the workplace. J Occup Environ Med 1997; 39: 320–7.
6. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd ed. (beta version). Cephalalgia 2013; 33: 629.
7. Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population – a prevalence study. J Clin Epidemiol 1991; 44: 1147.
8. Jensen R, Rasmussen BK, Pedersen B, Olesen J. Muscle tenderness and pressure pain thresholds in headache. A population study. Pain 1993; 52: 193.
9. Jensen R, Fuglsang-Frederiksen A. Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population. Electroencephalogr Clin Neurophysiol 1994; 93: 175.
10. Russell MB, Saltyte-Benth J, Levi N. Are infrequent episodic, frequent episodic and chronic tension-type headache inherited? J Headache Pain 2006; 7: 119–26.
11. Jensen R. Peripheral and central mechanisms in tension-type headache: an update. Cephalalgia 2003; 23 (Suppl. 1): 49.
12. Ashina S, Bendtsen L, Ashina M. Pathophysiology of tension-type headache. Curr Pain Headache Rep 2005; 9: 415–22.
13. Ashina M. Neurobiology of chronic tension-type headache. Cephalalgia 2004; 24: 161–72.
14. Bendtsen L, Schoenen J. Synthesis of tension-type headache mechanisms. In: Olesen J, Goadsby PJ, Ramadan N et al. (Eds.) The Headaches. Philadelphia: Lippincott Williams & Wilkins, 2005; p. 677–81.
15. Holroyd KA, Stensland M, Lipchik GL, Hill KR et al. Psychosocial correlates and impact of chronic tension-type headaches. Headache 2000; 40: 3–16.
16. Artemenko A.R., Osipova V.V., Filatova E.G. et al. Pervichnye golovnye boli khronicheskogo techeniia (diagnostika, klinika, terapiia). Metodicheskie rekomendatsii no. 26, Pravitel'stvo Moskvy, departament zdravookhraneniia g. Moskvy, 2014 (in Russian).
17. Dodick D, Freitag F. Evidence-based understanding of medication-overuse headache: clinical implications. Headache 2006; 46 (Suppl. 4): S202–11.
18. Ryan RE. Motrin – a new agent for the symptomatic treatment of muscle contraction headache. Headache 1977; 16: 280–83.
19. Diamond S. Ibuprofen versus aspirin and placebo in the treatment of muscle contraction headache. Headache 1983; 23: 206–10.
20. Schachtel BP, Furey SA, Thoden WR. Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache. J Clin Pharmacol 1996; 36: 1120–5.
21. Nebe J, Heier M, Diener HC. Low-dose ibuprofen in self-medication of mild to moderate headache: a comparison with acetylsalicylic acid and placebo. Cephalalgia 1995; 15: 531–5.
22. Moore RA, Derry S, Straube S et al. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain. Pain 2014; 155 (1): 14–21.
23. Packman B, Packman E, Doyle G. et al. Solubilized ibuprofen: evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache. Headache 2000; 40: 561–7.
24. 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: 1318.
25. Steiner TJ, Lange R, Voelker M. Aspirin in episodic tension-type headache: placebo-controlled dose-ranging comparison with paracetamol. Cephalalgia 2003; 23: 59–66.
26. Diener HC, Pfaffenrath V, Pageler L et al. The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Cephalalgia 2005; 25: 776–87.
27. Diamond S, Freitag FG. The use of ibuprofen plus caffeine to treat tension-type headache. Curr Pain Headache Rep 2001; 5: 472–8.
28. Scher AI, Stewart WF, Ricci JA, Lipton RB. Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 2003; 106: 81–9.
29. Bendtsen L, Jensen R. Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia 2000; 20: 603–10.
30. Bendtsen L. Central and peripheral sensitization in tension-type headache. Curr Pain Headache Rep 2003; 7 (6): 460–5.
31. Bettucci D, Testa L, Calzoni S et al. Combination of tizanidine and amitriptyline in the prophylaxis of chronic tension-type headache: evaluation of efficacy and impact on quality of life. J Headache Pain 2006; 7: 34–6.
32. Scripter C. Headache: Tension-Type Headache. FP Essent 2018; 473: 17–20.
33. Stetter F, Kupper S. Autogenic training: a meta-analysis of clinical outcome studies. Appl Psychophysiol Biofeedback 2002; 27 (1): 45–98.
34. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML et al. Are manual therapies effective in reducing pain from tension-type headache? A systematic review. Clin J Pain 2006; 22: 278–85.
35. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R. Prognosis of migraine and tension-type headache: a population-based follow-up study. Neurology 2005; 65: 580–5.

Авторы

О.В. Котова*1, А.А. Беляев2, Е.С. Акарачкова1

1 Международное общество «Стресс под контролем», Москва, Россия;
2 ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского» Департамента здравоохранения г. Москвы, Москва, Россия
*ol_kotova@mail.ru

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Olga V. Kotova*1, Аnton А. Belyaev2, Elena S. Akarachkova1

1 International Society "Stress under Control", Moscow, Russia;
2 Sklifosovsky Research Institute of Emergency Medicine, Moscow, Russia
*ol_kotova@mail.ru

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