Main symptoms.
1. headache mostly located in both foreheads and occipital and cervical regions, with persistent dull pain, patients often complain of tightness and heavy pressure in the head, without nausea and vomiting.
2. The headache may appear in the morning when waking up or soon after waking up, and may gradually worsen or remain unchanged all day.
3.Some patients have migraine headache in combination.
4. Some patients have the “empty pillow” sign.
Pathogenesis.
Tension headache is caused by persistent contraction of the muscles of the head and neck, and there are three causes of such contraction.
(1) As a result of anxiety or depression accompanied by mental tension.
(2) As a secondary symptom of other causes of headache or pain in other parts of the body.
(3) As a result of poor posture of the head, neck and scapular girdle.
The disease is extremely common clinically, mostly in women, and most often develops around the age of 30, and psychotherapy often yields good results.
The main causes of tension headache are mental tension caused by heavy study and work pressure, emotional abnormalities and severe lack of sleep, which cause abnormal blood supply to the brain vessels in the human body and cause cerebral vascular spasm, thus leading to headache. The pain is usually symmetrical, extending from the back of the head to the forehead, and the headache lasts about several hours. Dr J. Murtagh, an Australian medical authority, stated in 1994 that in addition to psychological factors, malfunction of the cervical spine is also a major cause of tension headaches.
Basic clinical examination
1.Electroencephalography and electromyography.
2.Ophthalmologic examination for special tension headache.
3.Radionuclide (isotope) examination, X-ray examination, magnetic resonance imaging (MRI) examination, CT examination.
Auxiliary examinations.
1.For the first diagnosis of headache patients, check box “A” should be used, and in some cases, 1 or 2 of check box “B” can be used.
2.For patients who cannot be cured or cannot exclude intracranial vascular malformation and headache type epilepsy, one or two items in box “C” should be used.
Clinical diagnosis
1.Headache mostly occurs around 30 years of age, mostly located in the two fronts and occipital and cervical regions, with persistent dull pain, and the persistence of headache is its main feature.
2.Some patients coexist with migraine.
3. Some patients have the “empty pillow” sign.
4. Exclude headache caused by brain tumor, hypertension, epilepsy and glaucoma.
Care modalities.
Points to note in nursing: 1.
1, mild headache generally do not need to rest can take painkillers such as painkillers, etc. If there is a severe headache must be bed rest
2.The environment should be quiet and the light in the room should be soft.
3. Pay attention to understand the PQRST of the patient’s headache so that the patient can be given the corresponding care in a targeted manner, and also pay attention to observe whether the patient’s consciousness is clear and whether there are symptoms such as facial and orofacial distortion.
4. Acupuncture and massage can be given according to the area of the headache, and acupuncture points such as Yin Tang, He Gu, Yang Bai, and Bai Hui can be used for pain on both sides, and Feng Chi and Wai Guan can be used for pain on the back of the headache.
5.Patients with headache, dizziness, irritability, poor night sleep, red face and bitter mouth should strengthen their mental care to eliminate the patient’s irritability and tension to avoid triggering other diseases.
6.For some headaches caused by clear diseases, the disease should be controlled first to relieve the pain.
How to care for patients.
1.Rest: Family members should guide patients to arrange a reasonable system of life and rest and pay attention to the combination of work and rest. Ensure sufficient rest and sleep time. Patients can make reasonable arrangements for rest and recreation according to their own life pattern and do not disturb their rest and recreation plan as much as possible. It is not advisable to take a full meal, smoke, drink strong tea or do excessive exercise before resting in the evening, take a hot bath or soak your feet in hot water, turn off the lights and create a quiet resting environment to reduce cortical excitability so that you can go to sleep as soon as possible.
2.Dietary care: Migraine patients should pay attention to the rationality of diet, avoid applying allergy-causing drugs and certain spicy and stimulating foods, fried and fried foods and foods with high tyramine content that easily trigger migraine, such as chocolate, cheese, citrus and alcoholic foods, and eat more cereals and legumes rich in vitamin B1 as well as fresh fruits and vegetables. Quit smoking and alcohol.
3.Psychological care: Although migraine is a physical disease in terms of symptoms, the onset and evolution of migraine are closely related to psychological factors. Therefore, migraine patients must be good at regulating their emotions, try to maintain a stable and optimistic psychological state, be calm and collected, learn to treat things objectively and rationally, not to be too happy, too sad, too angry or too worried, and if there are indeed problems that they cannot “digest” or “solve “problems, but also to learn to control emotions, self-regulation. For example, climbing mountains, running, playing ball, etc., to divert attention and relax the tense nerves, so as to reduce or eliminate the stimulation of bad emotions on the brain nerves and prevent the triggering of migraine. Family members should create a warm family environment for the patient, so that the patient can keep a happy mood, accept and understand the disease correctly, and give more psychological comfort to avoid bad emotional stimulation.
4.Control high blood pressure effectively.
5.Acupuncture has good effect on migraine head: the general acupuncture points are Fengchi, Head Wei, Sun and Hegu, etc. You can ask a Chinese medicine doctor for acupuncture treatment.
TCM treatment research.
Tension headache is due to persistent contraction of head and neck muscles, and there are three causes of such contraction.
(1) as a result of anxiety or depression accompanied by mental tension; (2) as a secondary symptom of other causes of headache or pain in other parts of the body; and (3) as a result of poor posture of the head, neck, and scapular girdle. The disease is extremely common clinically, mostly in women, and mostly develops around the age of 30. According to Chinese medical evidence, for the treatment of tension headache, some sedative and analgesic drugs and drugs to release vascular spasm can be used. However, many drugs can cause adverse reactions, such as drowsiness, gastrointestinal discomfort and other symptoms, which can affect bone marrow hematopoietic function and peripheral blood leukocyte reduction when taken repeatedly for a long time. Chinese herbal medicine can be used for treatment such as Singapore’s imported Chinese medicine Malai Sleep, for mild or severe patients have the ideal effect. For example, chrysanthemum clears the liver and brightens the eyes, which can significantly improve the headache caused by wind and Yang upheaval.
Pathogenesis.
Although tension-type headache is a common headache disorder, the pathogenesis of it has not been completely clarified so far, and in recent years tension headache.
The status of research is summarized as follows.
1. The relationship between TTH and pericranial muscle disorders has been discussed in the literature since 1940, but there is no conclusion as to whether muscle disorders are a cause or a consequence of TTH, or just one of the factors in the pathogenesis of TTH.
2. The relationship between TTH and psychological changes Catheart et al. (1998) conducted an experimental biopsychological study on the relationship between arousal-relatedmood and ETTH using the activation-deactivationadjective scale. They used the activation-deactivationadjectivechecklistADACL to score and quantify evoked energy, tediousness, tension, and quietness. In the non-headache period, the level of tension was significantly lower than that in the headache period. Therefore, it is believed that there is a relationship between tension and headache.
3. The relationship between TTH and vascular headache is due to the fact that both tension-type headache and migraine can be found clinically, and at the same time, occur in the same patient as well as in some patients who initially present with migraine, and when the frequency of attacks gradually increases, they present with ETTH and can then be converted to CTTH.
For example, Oishi et al. (1998) measured the levels of plasma platelet factor 4, β-thromboglobulin and 11-dehydrothromboxane B2 and found that the levels of these three substances were significantly higher in patients with ETTH than in the CTTH group and the control group. Mishima et al. (1997) found that serum platelet magnesium ion levels were reduced in patients with TTH and suggested that this might be related to enhanced platelet function. adrenaline levels were negatively correlated with headache intensity. In addition, monoamine levels were not found to correlate with the degree of depression. These results suggest that there is a change in the function of the central monoaminergic nervous system in TTH patients, which is not related to the ensuing depression, but to the pathophysiological mechanism of headache onset Marukawa et al. (1996) found a significant increase in salivary substance P and 5-hydroxytryptamine levels during headache attacks in TTH patients, suggesting that substance P is released by the nociceptive system.
In conclusion, the above examples show that the pathogenesis of TTH is still being studied from various aspects, including the relationship between headache and muscles, the relationship between headache and depression, and even the concept of whether “tension” refers to muscular tension or psychosomatic tension.
Differential diagnosis.
1.Migraine is a vascular headache common in young and middle-aged people and children. The headache is located in the temporal frontal orbit on one side, with throbbing pain, often accompanied by nausea and vomiting. The headache can be preceded by visual disturbances such as blurred vision, blind spots in the visual field or hemianopia, or the migraine can start without any aura, and usually lasts for several hours or days and is relieved in very few patients. In a few patients, migraine may coexist with tension-type headache, making it difficult to distinguish between the two.
2. Cluster headache is probably vascular and related to hypothalamic dysfunction. The headache is located on one side of the orbito-temporal frontal area, and in severe cases, the headache attacks are intensive and severe without aura. The headache attacks are rapid and can stop suddenly. The attacks are accompanied by conjunctival congestion, lacrimation and excessive sweating, and in some cases, ptosis. However, the remission period can last for months to years. It is not difficult to distinguish it from tension-type headache by detailed medical history and observation of attacks.
3.Trigeminal neuralgia is an episodic transient severe pain in the distribution area of the facial trigeminal nerve. The pain is only a few seconds each time, and it occurs several times to dozens of times a day. The pain is like cutting, burning or stabbing and is often triggered by washing, brushing, talking and chewing. Patients can often point out the location of the pain trigger, called the “trigger point”. The disease is more common in middle-aged and elderly people, and the 2nd and 3rd branches of the trigeminal nerve are more frequently involved. If the first branch is involved, it should be distinguished from ETTH.
4.Headache caused by intracranial occupational diseases include intracranial tumor, intracranial metastatic cancer, brain abscess and brain parasitic disease. These headaches are caused by increased intracranial pressure and are often accompanied by jet vomiting and fundus edema as the disease progresses, but they can be misdiagnosed as tension-type headache in the early stage. If pathological reflexes and other signs are found, it is often suggested that it is not tension-type headache and brain CT or MRI should be used in time to help differentiate.
5, headaches caused by chronic intracranial infections such diseases include tuberculous meningitis fungal meningitis porcine cysticercosis (cysticercosis) meningitis and syphilitic meningitis. However, in some atypical patients, the initial fever is low and the meningeal irritation sign is negative, which is easily misdiagnosed as tension-type headache. Therefore, when taking medical history, whenever there is a recent history of “cold” or suspicious pathological reflexes are found on physical examination, lumbar puncture should be considered in time for detailed testing of cerebrospinal fluid pressure, cytology, biochemical tryptophan and ink staining and other routine laboratory tests. If necessary, anti-tuberculosis antibodies in blood and cerebrospinal fluid, immunoassay for porcine cysticercosis (cysticercosis) and syphilis test should be tested simultaneously to help clarify the diagnosis.
6, autoimmune meningoencephalitis headache caused by such diseases include neuroleukopenia, Vogt-Koyanagi-Harada syndrome and central nervous system nodular disease. These diseases can cause inflammatory reaction and headache when they involve the meninges or the main mass of the brain, and are not necessarily accompanied by fever, so they are easily misdiagnosed as tension-type headache. The exclusion of these diseases is based on a detailed history, a thorough physical examination and CT or MRI examination of the brain. Vogt-Koyanagi-Harada syndrome is also known as uveal meningoencephalitis, so there should be ocular damage, and those who have been ill for more than a few weeks often have clinical manifestations such as gray hair, alopecia and white skin. There are often focal signs in the brain and CT or MRI of the brain shows granulomatous damage.
7.Headache due to abnormal intracranial pressure These diseases include benign intracranial hypertension and normal cranial pressure hydrocephalus. These patients all have headaches mainly like tension-type headaches intracranial low pressure syndrome is mostly due to excessive absorption or decreased secretion of cerebrospinal fluid due to water loss and infection may be its cause benign intracranial hypertension is often accompanied by visual impairment. It may be triggered by overdose of tetracycline or vitamin A, empty saddles, and pregnancy. Normal cranial pressure hydrocephalus is commonly seen after traumatic brain injury or during the recovery period of subretinal space hemorrhage, and its pathogenesis may be related to impaired absorption of cerebrospinal fluid. These disorders can be identified by lumbar puncture to measure cranial pressure and brain CT.
Medical treatment.
Treatment of tension-type headache can be divided into pharmacological and non-pharmacological treatments.
Since the pathogenesis of tension-type headache is not clear, mild non-narcotic painkillers are used to reduce symptoms, mainly non-steroidal anti-inflammatory drugs (nonsteroidal anti-inflammatorydrugNSAID). Other drugs include moderate amounts of muscle relaxants and light sedatives, antidepressants are also often applied according to the condition, and are usually given orally and applied for a short period of time to avoid toxic side effects of the drug.
(1) Ketoprofen (ketone ibuprofen): belongs to the NSAID class, in addition to tension-type headache is also suitable for muscle and joint pain pain relief is temporary, its effect is to inhibit prostaglandin synthesis, increase intracellular cAMP, improve platelet function. The oral dose is 12.5~25mg/dose. Toxic side effects are stomach upset, nausea and diarrhea, palpitations and sweating, drowsiness and skin itching.
(2) Naproxen: belongs to NSAID class. By inhibiting the synthesis of dinoprost (prostaglandin) and play a pain-relieving anti-inflammatory effect. The oral dose is 100-200mg/dose, usually 2-3 times/d. Toxic side effects are nausea, stomach discomfort, fatigue, dizziness, weakness, and sleepiness, which are prohibited for pregnant and lactating women.
(3) Proquazone: It is an NSAID for acute tension-type headache. Its pharmacological effects include inhibition of the prostaglandin system and dinoprost (prostaglandin) is considered to be the physiological mediator of headache, inhibition of platelet aggregation, inhibition of 5-HT release, reduction of capillary permeability and inhibition of bradykinin. The oral dose is 75-150mg/dose, and the toxic side effects are nausea, vomiting, sleepiness, etc.
(4) Amitriptyline (amitriptyline): tricyclic antidepressants are early drugs used for chronic tension-type headache with depressive symptoms. This drug is both a norepinephrine reuptake inhibitor and a 5-hydroxytryptamine reuptake inhibitor. The latter was previously thought to be the main pathway of pain relief, but recent studies have concluded that there is no difference between the above two effects on pain relief and that the improvement of headache is indirect, mediated by the antidepressant effect.
(5) Eperisone: It is a skeletal muscle relaxant, which can inhibit hypertonia and pain reflex activity, thus improving the symptoms of tension-type headache. Oral dose 150mg/d in divided doses. Toxic side effects are nausea, vomiting, stomach discomfort, diarrhea, weakness, drowsiness and unsteadiness, and caution for those with a history of drug allergy and liver disease; prohibited for pregnant and lactating women.
2.Non-pharmacological treatment physical therapy can improve tension-type headache some scholars use a treatment program consisting of four parts.
(1) Training the correct posture of the neck and head while sitting, standing, sleeping and working.
(2) Practicing improved head position and prone position exercises at home to strengthen the muscles at the back of the neck and placing ice packs on the back of the neck.
(3) Perform medium to deep massage in the back and shoulders for 2 min.
(4) Passive stretching of the upper trapezius rhomboid, shoulder lift and pectoralis muscles for 5 min, and passive exercise of the anterior neck muscles if necessary according to the condition (Harmmill 1995).
In addition, according to the theory of Chinese medicine in China, acupuncture and massage treatment have certain efficacy. In recent years, some TCM drugs have been developed and applied to clinical practice in China. The characteristics of these drugs are based on the understanding of TCM theory of headache, and they can be used for both the symptoms and the root cause, which can be prevented and treated with less toxic side effects. Whether applied alone or in combination with western medicine, or even with physical and psychological treatment, good results can be achieved.
Treatment principles: 1.
1. Attack period: control the headache.
2. Relieving period: prevent attacks.
Treatment key.
Tension headache is also called muscle contraction headache. As the name suggests, it is also the headache caused by abnormal twitching and spasm of small muscles in the brain, and this local abnormal twitching and spasm of small muscles is related to two reasons.
1, heavy study and work pressure caused by mental tension, emotional abnormalities and serious lack of sleep, etc., so that the human cerebrovascular blood supply abnormalities, causing cerebrovascular spasm, which leads to headache.
2. The physiological magnetic field of the human brain loses its proper balance due to various external stimulating factors, resulting in the imbalance of neuroelectric ion balance in the brain, which leads to, disorderly twitching and spasm of the muscles innervated by neurons.
In many cases, the onset of tension headache is often persistent, and many drugs, especially western drugs, mainly vasodilators and antispasmodics, can provide appropriate relief when used, but after stopping the drug, the headache will recur. And can not well regulate the human brain muscles, vascular diastolic function. In the long run, it creates a great problem for the quality of life of patients with long-term recurrent tension headache. At present, it is recommended that patients with recurrent and persistent tension headache use a kind of domestic medical device called “analgesic sleeping pad”, which adopts NdFeB permanent magnet, a high-tech achievement of the national 863 plan, and is padded with nano far-infrared cloth. The NdFeB high-tech magnetic field, magnetic field frequency and the body’s own magnetic field can produce coordination, not only will not cause the body’s own magnetic field disorder, more importantly, it can promote the body’s bioelectromagnetic energy enhancement, promote the body’s meridian qi operation, so as to achieve the effect of the effective pain relief through the meridian. Under the action of biomagnetic field, local blood circulation is improved, while capillary permeability is reduced, resulting in strong relief of tension headache. What’s more, because of the consistent magnetic field strength, the analgesic sleeping pad can well restore the normal diastolic function of human brain blood vessels and correct the imbalanced physiological magnetic field of the brain, thus achieving good results. Because it is valid for up to five years, it is more suitable for the treatment of persistent recurrent tension headaches.
Treatment.
If one already has tension headache.
Non-pulsating pain, splitting headache, inability to sleep, with irritability, insomnia, memory loss, agitation and other neuroses. When the headache is severe, you can take phenol curry tablets, or you can take weak tranquilizers, such as Valium and Advil, which help to release mental tension and relax muscles. You can also turn your neck and massage yourself to relieve the symptoms.
There are many Chinese herbal treatments for headache, such as dahurica, which has obvious pain-relieving effects; Chuanxiong, which has the effect of activating blood circulation, clearing the channels and relieving blood vessel spasm; and Chrysanthemum, which clears the liver and brightens the eyes and can significantly improve headache caused by wind and Yang upheaval. It is possible to let the physician carry out TCM diagnosis and treatment after specific analysis of the degree and constitution of the condition, so as to reduce the number, duration and frequency of headache attacks, improve the symptoms and then make the headache disappear gradually.
Preventive care.
To prevent the attack of tension headache.
First, pay attention to the warmth in the morning and evening, pay attention to the increase and decrease of clothes in the morning, in the middle and at night; second, pay attention to the diet of eating more sour and sweet things that nourish Yin, such as tomatoes, lilies, green vegetables, strawberries, oranges, etc., and avoid spicy and greasy food; third, regulate emotions, do not give yourself too much pressure, do not bury your head in books all day and night, get out of the house more often to exercise outdoors, try to relieve and relax emotions.
Fourth, less cold wind, reduce their own stress, learn to do deep breathing to adjust the psychological tension and depression, and drink more water. (Most headache conditions are caused by dehydration).
Fifth, try to increase their own rest and sleep time, because adequate rest can relieve mental tension and depression. Especially in the middle of the day, sleeping in the middle of the day is a good choice.
Daily care methods.
Tension headache patients mostly have nervous tension, emotional instability and easy to get angry, etc. When headache symptoms occur, patients can obviously feel a dull pain, pressure and heavy feeling in the head. Therefore, in the daily care of tension headache patients, the following points should be noted.
1. To arrange the time of work and rest reasonably, never work long hours, which will only aggravate the headache symptoms. In addition, headache patients should maintain a good mood every day, and mentally eliminate tension, anxiety and boredom. The diet should be light.
2.When tension headache attacks, self-observation of the headache should be made. It is better to record the time, degree and nature of each headache with a small notebook, and at the same time, pay attention to whether there is vomiting, nausea, reduced vision and twitching of limbs when neuropathic headache occurs. If you have the above symptoms, it is better to go to the hospital for examination in time.
3.When there is a mild tension headache, it is better to be able to treat the symptoms. Like some people have allergies after consuming eggs, meat, seafood, etc., thus triggering the symptoms of migraine, there are also some. When the situation is more serious, patients had better go to the hospital for a checkup and use drugs and other methods of symptomatic treatment.
4.In daily life, pay attention to the combination of labor and service, avoid the emergence of unstable emotions, do not overwork yourself, do not smoke, drink, and diet should also be moderate.
5.Pay attention to personal hygiene. Some disease infections can cause headache symptoms, like dental diseases.
6.Nervous headache caused by long-term depression should not be ignored. When the headache is accompanied by dizziness, it is better to have a CT examination.