Medical Treatment and Therapy for Tension Headache

Tension Headache Treatment
      The principle of treatment is psychologic approach (psychotherapy), physiological (relaxation) and pharmacological (analgesic, sedative and minor transquilizers). In practice, it needs an adequate explanation of the background of the pain that the patient understands, about the issues that are less or not realized.
       An explanation of the various kinds of additional checks are necessary and which do not need to be very beneficial for patients.

      Analgesics such as acetaminophen or aspirin or other NSAIDs are very usefull, but only for a short time. Tension headaches respond best to the drug use, carefully one of the few drugs that reduce anxiety or depression , when the last symptoms arise .

     Some patients respond to such an ancillary measure massage, meditation and biofeedback techniques. Stronger analgesic treatment should be avoided. It has been reported, the success of therapy with a calcium channel blocker, phenelzine or cyproheptadine. Ergotamine and propranolol are not effective unless there are symptoms of migraine and tension headaches. Relaxation techniques help a patient how to deal with anxiety and stres.

Treatment and therapy :
a.  Rest in darkened room until symptoms diminish and disappear.
b.  Taking pain medications such as aspirin, acetaminophe , ibuprofen.
c.  Massage the neck, shoulders and back. head compress using ice pack, or a cold washcloth on the area of ​​pain.
d. Immediately to the doctor if :
   - headache more pain than usual
   - Vomiting repeatedly .
   - numbness or tingling of the face, arm or leg .
   - arms and legs were weak .
   - visual changes that do not immediately disappear

Pharmacologic therapy :
• Serotonin agonists, opioids, baclofen (GABA agonist) and clonidine inhibits antidromic release of SP, by activating presynaptic .

• NMDA receptors play a role in the phenomenon of wind-up and central sensitization . Giving systemic ketamine can reduce allodynia and hyperalgesia . Ketamine is an NMDA antagonist may be used to modulate chronic pain .

• Artemin is one type of family of Glial - Derived Neurotrophic Factor cell ( GDNF ) has the effect of antihyperalgesic and antiallodynic effect by way of normalizing the release of CGRP, SP and P2X3 receptors , neuropeptide Y receptor selective against artemin can not be definitely identified. Artemin also produced along the blood vessels that serve the sympathetic axon .

• Non-selective serotonin reuptake inhibitors (NSSRi) Drugs, such as amitriptyline significantly as a prophylaxis against chronic Tension headache, reduce the intensity, duration and frequency of about 30 %. whereas other antidepressant drugs such as highly selective SHT reuptake inhibitor (citalopram) only reduces 12 % just is not significant.

• Antidepressants also have a direct analgesic effect by inhibiting the reuptake of serotonin, it has the effect of amitriptyline higher than analgesic drugs and noradrenaline reuptake inhibitors SSRIs. Anticipated effects of analgetiknya primarily as an NMDA receptor antagonist effects. Amitriptyline also has the function of potentiating the effects of endogenous opioids. Proved that the levels of Metenkephalin in the cerebrospinal liquor Tension Headache sufferers of chronic elevated, but normal levels of β -endorphin .

• COX - 2 inhibitors also play a role in central nociceptive mechanisms. COX 2 inhibitors can reduce neuronal processes and nociceptive excitoxicity spreading depression are mediated by NMDA. Selective COX - 2 inhibitors that can penetrate the brain also has a good therapeutic effect . COX - 2 inhibitors have the potential core inflammatory analgesic similar to indomethacin and has a better tolerability

• Systemic Capsaicin acts as a sensory neurotoxin that lowers the levels of immunoreactive nerve fibers SF - NKA immunoreactive nerve fibers and in the cerebral vasculature. As it is known that SP layout together with NKA in cerebrovascular nerve fibers and cell bodies in the trigeminal ganglion. Capsaicin is fast or slow, can degrade the neurotransmitter SP in sensory fibers, particularly topical administration. Capsaicin activates smear gate vanilloid receptor (VR - I) so that the cations can pass through cell

• Nitric Oxide Synthase (NOS) inhibitor (L-NAME) has been shown to be effective for the treatment of acute migraine and chronic Tension Headache .

• anticonvulsants such as carbamazepin, phenytoin, lidocaine (and its oral analogue: mexiletine) blockade of sodium channels are not specific and reduce excitabilitas neurons in C nociceptors that have undergone sensitization. Lamotrigine stabilizes one subtype of the sodium channel, because it can inhibit or reduce the release of glutamate. Gabapentin whoose structure analogous to GABA (although its receptor or functions unclear biochemical) turns out to have an effect on the release of GABA or GABA synthesis. So that gabapentin may be used for the treatment of postherpetic neuralgia, neuropathic pain and other migraine syndrome. Valproic acid is a GABA agonist, which increases the effectiveness of GABA by inhibiting GABA catabolism and inhibits plasma extravasation in the duramater.

• Mepyramine is an H1 antagonist that blocked the histamine -induced headache process, while for NTG (nitriglycerine) induced headache can be blocked with a steroid that can inhibit iNOS (Nitric Oxide Synthase inducable ) so as to decrease the production of NO inducable.

Non-pharmacologic therapy:
1. Regulation of lifestyle
     - Maintain regular sleep schedule
     - Eat regular meals
     - Avoid known dietary triggers
     -  Get regular aerobic exercise
2. Minimization of emotional stressors
    - Plan ahead and avoid stressful situations
    - Learn biofeedback
    - Meditate
    - Increase undemanding leisure activities, hobbies, social events
    - Learn other relaxation techniques (eg, progressive muscle relaxation, visualization)
    - Consider individual or family psychotherapy
3. Avoidance of environmental precipitants
    - Wear sunglasses
    - Avoid smoke, strong odors, and noisy areas
    - Maintain proper posture; limit sustained positions
4. Physical therapy techniques
    - Heat, ice, ultrasound, transcutaneous electrical nerve stimulation
    - Massage or cervical traction
    - Stretching and strengthening exercises for cervical musculature
    - Trigger point stretching, compression, injection (any or all)
5. Osteopathic or chiropractic manipulation
6. Alternative therapies

    - Acupuncture
    - Acupressure
    - Therapeutic touch
    - Aromatherapy (eg, peppermint, green apple)
    - Topical salves (eg, salicylic acid, piroxicam [Feldene], ketoprofen [Orudis, Oruvail])

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1 comment:

  1. It is very nice that you consider medical treatment and therapy.


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