Wednesday, December 19, 2018
Wisdom Wednesday: Tension Headaches
Tension-type headache is very common, with a lifetime prevalence in the general population ranging in different studies between 30% and 78%. It has a high socio-economic impact. While it was previously considered to be primarily psychogenic, a number of studies since ICHD-I strongly suggest a neurobiological basis.
The division of 2. Tension-type headache into episodic and chronic types, introduced in ICHD-I, has proved extremely useful. In ICHD-II, the episodic type was further divided into an infrequent type, with headache episodes less than once per month, and a frequent type. 2.2 Frequent episodic tension-type headache can be associated with considerable disability, and sometimes warrants treatment with expensive drugs. In contrast, 2.1 Infrequent episodic tension-type headache, which occurs in almost the entire population, usually has very little impact on the individual and, in most instances, requires no attention from the medical profession. The distinction of 2.1 Infrequent episodic tension-type headache from 2.2 Frequent episodic tension-type headache thus separates individuals who typically do not require medical management, and avoids categorizing almost the entire population as having a significant headache disorder, yet allows their headaches to be classified. 2.3 Chronic tension-type headache is a serious disease, causing greatly decreased quality of life and high disability.
The exact mechanisms of 2. Tension-type headache are not known. Peripheral pain mechanisms are most likely to play a role in 2.1 Infrequent episodic tension-type headache and 2.2 Frequent episodic tension-type headache, whereas central pain mechanisms play a more important role in 2.3 Chronic tension-type headache. Increased pericranial tenderness is the most significant abnormal finding in patients with any type of 2. Tension-type headache: it is typically present interracially, is exacerbated during actual headache and increases with the intensity and frequency of headaches. Increased tenderness is very probably of pathophysiological importance. ICHD-II therefore distinguished patients with and without such disorder of the pericranial muscles, a subdivision maintained in ICHD-3 to stimulate further research in this area.
Pericranial tenderness is easily detected and recorded by manual palpation. Small rotating movements with the index and middle fingers, and firm pressure (preferably aided by use of a palpometer), provide local tenderness scores of 0-3 for frontal, temporal, masseter, pterygoid, sternocleidomastoid, splenius and trapezius muscles. These can be summed to yield a total tenderness score for each patient. These measures are a useful guide for treatment, and add value and credibility to explanations given to the patient.
The diagnostic difficulty most often encountered among the primary headache disorders is in discriminating between 2. Tension-type headache and mild forms of 1.1 Migraine without aura. This is more so because patients with frequent headaches often suffer from both disorders.
Tension headaches respond readily to chiropractic manipulation. It is often quite easy to relieve a patient from the symptoms of a tension headache while in the office. Prevention, however, is more difficult. I consider all tension headaches to be secondary and strive to find the cause(s) using the QA (Quintessential Applications) protocol.
Typically, an imbalance in the immune system is the root cause of tension headaches. Low grade infections and toxins are common culprits. Supplementation of vitamin D and B12 provide base support for the immune system. A variety of herbs is then recommended based on the offender.
If you suffer from frequent tension headaches seek help from a chiropractor who is also a qualified nutritionist. The combined approach is very effective at relieving and eliminating these types of headaches.
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