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Al Gutterman

June 16th, 2009 |

Tension headache, tense muscles â € "another myth!

So you have tension-type headache â € "How you feel about this diagnosis?

This probably was almost a line shot and immediately dismissed it nothing to worry â € "there to continue with your life! But in my experience, often € ~ â € ™ typeA tension headache, while usually less severe than a â € ~ Migraineâ € ™, is more annoying with proof of this, the impossibility of getting rid of him, as below. One wonders whether it would be better to have a pain intense for a day and then be free of pain for a period of time!

Over 150 years ago, mainly due to vibration nature headache, it is assumed that the main problem was (expansion or dilation) of blood vessels â € "and given that any headache that was / is pulsatile in nature was diagnosed with migraine and throbbing headaches were not excluded from a diagnosis of migraine â € "the idea developed tension headache, because despite the lack of evidence, the cause of non-throbbing headache muscle was found (in the scalp and forehead) and / or stress, and another hypothesis is made!

However, a baseline study (1) in the 1970s showed that:

– Tension in the muscles of the scalp and forehead in patients with tension headache during a headache was not different in the group without headache;

– Tension suffering headaches had increased (and more) the tension in the neck muscles, compared with the group without headache â € "such time indicating that tension headache is a headache of cervical origin are not recognized

Other research (2) showed that headache was significantly reduced tension after the rehabilitation is the treatment of the neck muscles neck, providing more evidence that tension headache is really a headache with its origin in the neck.

A significant number of recent studies have shown that sensitization or hyperexcitability of the brainstem is the disorder earlier in patients with tension-type headache (this is also the case of migraine â € "supporting the idea that tension headache and migraine are separate, but the conditions are different expressions of the same condition) â € | and that this awareness is present that is, constantly, even when the TTH free â € "confused? addition, the triptans € ~ â € ™, medication developed specifically for migraine, are also effective in eliminating tension headache. But â € | donâ € ™ t the â € ~ triptans € ™ work by reducing the dilation of blood vessels? Well initially it was thought (and largely assumed) to be the case, but the experiments have shown that the decrease in the sensitization of brainstem triptans.

Now, what is this thing called the â € ~ brainstem € ™. The brainstem is an area on the top of the spinal cord, which receives contributions from (activity) of the internal structures of the head (including the blood vessels) and also the structures of the upper neck (ligaments, joints and their capsules and muscles) that are provided by the first three spinal nerves. The brain stem is also influenced by serotonin and a system known as diffuse noxious inhibitory control system â € " donâ € ™ t be overwhelmed by these terms â € "I will explain elsewhere. Now, all the information or activity in relation with headache, head pain and migraine, passes through the brain stem to higher brain centers where it is interpreted, where decisions are made! The brainstem is headache what the black box is the plane â € "is the final common pathway for all migraine headaches and information.

The question remains the leading cause of sensitization.

As I mentioned before that the brain stem is influenced by four systems. The serotonin system and the diffuse noxious inhibitory control system (DNIC) act to inhibit or desensitize the brain stem â € "although the system not work satisfactorily then the brain stem that become sensitive or hyper excitable.

Iâ € ™ m sure you have heard of serotonin and itâ € ™ s role in the head. Serotonin is a neurotransmitter and its function is to act as a filter, screening out a minimum or non-fatal (pain) signals. Under normal circumstances, serotonin levels satisfactory counteract pain signals. However, the levels of serotonin in the headache that often suffer are too low. Research has shown a clear relationship. When injected with a drug that depletes serotonin, the test subjects have headaches. Just Thus, when they were injected with serotonin, headaches were relieved â € "so it is possible that the brainstem is sensitive to unsatisfactory levels serotonin;

or,

The diffuse noxious inhibitory control system (DNIC) is poorly understood. This mechanism involves a reduction in pain awareness when the pain is felt simultaneously in other parts of the body. For example, headache or migraine pain is perceived as much, much less severe after having beaten to his thumb with a hammer! If the DNIC is poor, then it would be like hitting your thumb with a hammer much smaller, and his headache would only slightly less severe. Perhaps therefore, the sensitization of the brain stem may be secondary to a disorder of the DNIC. However, research results at the same time have been inconsistent, a landmark study (3) has shown that this is unlikely in patients with migraine. Other research has also shown that DNIC plays a lesser role in women â € | and of the sexes, women are more susceptible to headaches, making it less likely DNIC concerned;

or,

Sensitization or hyperexcitability of the brainstem may also occur as a result of the current signs of an injury or abnormal a harmful disease of the upper neck structures including the joints, muscles and ligaments;

or,

Awareness also could result from a similar situation, ie current abnormal messages from a disorder of a structure from the inside of the head, for example, an infected tooth, a Sick sinus (despite a sinus headache is rare), meningeal irritation â € |

However, the results of the study conducted decisive at the end of 1970 (1) and more recently (2) suggest that the most likely source of awareness is in the neck. My clinical experience overwhelming supports these findings.

The evidence has led to a shift in the muscles of the forehead and scalp as the cause of headache and stress is now focused in â € œWhat is causing brainstem awareness? â € â € | â € | why is there so much energy, so many resources â € when it is so obvious "reason is that the role of the neck does not fit the medical model of headache and migraine, and so the model has shown little interest in exploring this as an option. It is essential that all factors, which have the potential to sensitize the brain stem, is researchers alike.

Currently, this is not the situation â € "the neck is largely ignored.

Stay tuned â € |!

Dean

Dean H Watson

Consultant Headache and Migraine Physiotherapist, International Teacher, Director, Pain Clinic head and Watson Headache Institute, a PhD candidate at Murdoch University, Western Australia; Assistant Lecturer, Masters Program, School of Physiotherapy at the University of South Australia; MAppSc (Res) GradDipAdvManipTher

Experienced health professionals trained in the Watson Headache Approach the exam and treatment techniques developed by Dean Watson. These techniques are based on extensive experience of 7000 patients with headache (21,000 hours) and over 21 are taught now internationally.

For your nearest doctor who has completed training in the â € ~ Watson Headache Approach € ™ please refer to the â € ~ Professional Directory € ™.

(Anthony M, Hinterberger H, Lance JW. Plasma serotonin in migraine and stress. Arch Neurol 1967; 16:544 â € "52.

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Fullerton T, Komorowski-Swiatek D, Forrest A, Gengo FM. The pharmacodynamics of sumatriptan in nitroglycerin-induced by headache. J Clin Pharmocol 1999, 39 (1) :17-29

Goldhammer L. Second cervical root neurofibroma and ipsilateral migraine. Cephalalgia 1993, 13:132

Hoskin KL, Kaub H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain 1996, 119:1419-28

Jansen J, Markakis E, Rama B, Hildebrandt J. hemicranial attacks or permanent hemicrania â € "a sequel of upper cervical root compression. Cephalalgia 1989; 9:123-30

Katsavara Z, Giffin N, Diener HC, Kaub H. Abnormal habituation € ~ â € ™ nociceptiveâ blink reflex in the â € migraine "evidence of increased excitability of trigeminal nociception. Cephalalgia 2003, 23:814-819

Katsavara Z Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaub H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453

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Lipton RB, Walter FS, Cady R, Hall C, Oâ € ™ Quinn S, Kuhn T, Gutterman D. Sumatriptan for the range of headaches in migraine patients: Spectrum Study Results. Headache 2000; 40 (10), 783-791

Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38

Nardone R et al trigemino-cervical reflex abnormalities in patients with migraine and cluster headache. Headache 2008, 48 (4) :578-585

Nardone R, Tezzon F. The trigemino-cervical reflex in tension headache. European Journal of Neurology 2003, 10 (3) :307-312

Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitization in patients with migraine. Neurosci Lett 2002, 317:135-138

Serrao M, Perrotta A, Bartolo M, Fiermonte G, Pauri F, Rossi P, Parisi L, Pierelli F. Major trigeminal-cervical-spinal reflex recovery cycle in migraine pain Free. Headache 2005; 45:1061-1068

Supornsilpchai W, S Sanguanrangsirikul, Maneesri S, A. Srikiatkhachorn depletion of serotonin, spreading depression cortex, and trigeminal nociception. Headache 2006; 46:34 â € "9

van Ettekoven M, Lucas C. Effectiveness of physiotherapy as a training program craniocervical for tension headache, a randomized clinical trial. Cephalalgia 2006, 26 (8) :983-91

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The information on this website is not to be a substitute for professional medical advice, diagnosis or treatment. Reading this article means acceptance and understanding of the Terms of YourHeadacheSolutions.co.uk.

About the Author

Dean Watson of YourHeadache Solutions, Consultant Headache and Migraine Physiotherapist; Adjunct Lecturer, Masters Program, School of Physiotherapy, University of South Australia; PhD Candidate, Murdoch University, Western Australia. On his site you can search all topics about headache migraine, headache treatment, migraine treatment, headache causes, migraine causes headache symptoms and more.

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