Dr Shweta B Nanjannavar
Dr Poojarani H Adoni
ABSTRACT
Headache disorders are among the most pervasive disorders globally. India too gives an impression of not being excluded. The recognition of their significance for the general wellbeing of public health has come only since 2000. The delay has occurred as the headache isn’t deadly and does not bring about any physical or mental abnormality. Tension type headache is very common, with lifetime prevalence in the general population with different studies and it has a very high socio-economic impact. These headaches were previously known by many terms such as psychogenic headache, stress headache, psychomyogenic headache, muscle contraction headache, etc. However, the term ‘tension type headache'(TTH) has been chosen by the International Classification of Headache Diagnosis1(ICHD1)in 1988 and have been retained by (ICHD 2) in 2004. There is insufficient evidence to support or refute the use of homeopathy for tension type headache through previous meta analysis and systematic reviews. Two earlier prospective observational studies demonstrated improvement in patients receiving homeopathic care in Tension headache but no latest studies were available through Homoeopathic search database. This review discusses the clinical aspects of Tension type headache its diagnostic criteria, aetiology , pathology, clinical features and, its management with Homoeopathic Perspective . The aim of this literature review is to evaluate the clinical trials, testing the efficacy of Homeopathy for these indications.
KEYWORDS – Tension type headache (TTH) , International Classification of Headache Disorders (ICHD), Chronic Tension Type Headache (CTTH),
INTRODUCTION
Since the existence of humans from ancient times, headache has been depicted. Travelling across various modes such as the sign of evil, fallacy, magic, theology, and medicine. It has contacted the poor, the rich, the famous personalities making the minds of the earliest physicians difficult to understand, who excitedly looked for means to clarify its events and strategies for its treatment. Its history dates back nearly 4000 years to the ritual texts of Mesopotamia[14]. Today the advanced knowledge of aetiology , classification , pathophysiology, and its treatment is known by the efforts of researchers of historical times. Although the first descriptions of headaches were recorded by the ancient Egyptians in the Ebers Papyrus, it was not until Hippocrates that headaches were classified as different types and attributed to real physical pathological states[15].
The developing way of present day lifestyles such as fierce competition and corruption insecurity of fixed income, risk of unemployment resulting in the breakdown of the defense mechanism of normal mentation paving the way to for headache disorders.
The human beings of the current generation are restlessly behind their never ending necessities. Tofulfill these necessities changes in their lifestyle has taken place like irregular diet pattern, lack of sleep, no access to entertainment, Insufficient time for relaxation, leading to a disorder like a tension headache.
Tension type headache (TTH) is a recurrent episode of headache lasting minutes to weeks. The pain is typically pressing or tightening in quality that occurs in the frontal or occipital, of mild to moderate intensity and bilateral in location, and does not worsen with the routine physical activity, nausea and vomiting are usually absent, but photophobia or phonophobia may be present[7].
Tension type headache is very common, with lifetime prevalence in the general population ranging between 30% and 78% in different studies and it has a very high socio-economic impact. Although this type of headache was previously considered to be primarily psychogenic, several studies have appeared after the publication of ICHD-1 that strongly suggest a neurobiological basis, at least for the more severe subtypes of tension type headache[3].
EPIDEMIOLOGY
In the global burden of disease 2010 tension type headache was added. A study on systematic analysis for the global burden of disease 2016 published by Elsevier 2018 reported that tension type headache (TTH) was the 28th most prevalent disorder. Its global age-standardized prevalence was 26.1% overall: 30.8% for women and 21.4% for men.The global one year prevalence of tension type headache (TTH) estimated 32%(30% for episodic tension type headache,2.4%for chronic tension type headache) chronic tension type headache rates range from (0.6% to 3.3%)[1]. A study based on headache disorders in Karnataka, its prevalence estimated that all headaches on ≥ 15 days /month were 3.0% with slightly higher among females than males and more prevalent among younger people (male and female)in this country[4].
CLASSIFICATION
The International Classification of Headache Disorders (ICHD)was first published in 1988 and has now gone through 2 revisions, most recently in 2013
The division of 2.Tension type headache into episodic and chronic subtypes, which was introduced in ICHD-1, has proved extremely useful. In ICHD-2, The episodic form was further subdivided into an infrequent subform with headache episodes less than once per month and a frequent subform.2.3 Chronic Tension Type Headache is a serious disease causing greatly decreased quality of life and high disability[3].
These headaches were previously known by many terms such as psychogenic headache, stress headache, psychomyogenicheadache, muscle contraction headache, etc. However,the term ‘tension type headache'(TTH) has been chosen by the International Classification of Headache Diagnosis1(ICHD1)in 1988 and have been retained by (ICHD 2) in 2004[7].
An initiative to stimulate further research into the mechanism and mechanism of tension type headache prompted the release of third addition beta version of the international classification of headache disorder(ICHD-3rd Edition BETA VERSION) in 2013[6].
AETIOLOGY AND PATHOLOGY
The exact pathophysiology of tension type headache is unknown, but many studies show that there is increased stimulation of myofascial tissue from a few triggering factors like stress, caffeine abuse unhealthy eating habits or sleep deprivation, etc., which may cause increased tension in the musculoskeletal system of the head and neck and causes pericranial tenderness[5].
Genetic factors are most certainly involved in tension type headache pathogenesis with a higher genetic influence for frequent episodic tension type headache than in frequent episodic tension type headaches. The population relative risk in relatives of individuals with chronic tension type headache was increased threefold compared with normal controls.
The exact neurological mechanism of tension type headache is unknown. Althoughtension type headache was previously considered primarily psychogenic, recent evidence indicates a neurobiological basis. Chronic tension type headache is related to sensitization of pain pathways in the central nervous system resulting from prolonged nociceptive stimuli from pericranialmyofascial tissues[6].
Research using magnetic resonance imaging(MRI) voxel-based morphometry showed that patients with chronic tension type headache have significant gray matter decreases in areas of the brain involved in nociceptive transmission .chronic tension type headache is associated with structural and functional changes in the brain. By utilizing these findings, future interventions may provide better treatment outcomes for people with tension type headache
Precipitating and aggravating factors like stress, lack of sleep, and not eating on time are among the most common headaches precipitant. Diurnal variations is often reported to start at some time during the day and to increase slowly, some people may have an aggravation by late evening
Physical examination: Good and detailed clinical history is required.The physical examination includes manual palpation of the pericranial muscles to identify tender points and trigger points[7].
CLINICAL PRESENTATION:
The pain is characterized by bilateral tight, a band like a discomfort .The pain typically builds slowly,fluctuates in severityand may persist more or less continuously for many days.The headache may be episodic or chronic (present >15 days per month).
The pain is usually described as dull ,pressure like constricting or giving a sense of fullness in the head,wearing a tight hat or bearing a heavy burden on the head.Physical activity has no influence on headache intensity in the majority of patients. Photophobia or phonophobia may be present while the presence of both symptoms is not allowed[8].
- J Henry Allen –
- In Chronic miasms-
In Psora – psoric headaches are usually frontal, temporal or temporo-parietal .Headache with nausea, coming once or twice a month, are usually of psoric origin.
In Sycosis – Frontal headache is seen[10].
PATIENT HISTORY AND EXAMINATION
A detailed history of the patient’s headache is of utmost importance in making the correct diagnosis. Information gathered in the history is compared with the diagnostic criteriato create the best diagnostic match. The history records details about the headache, such as frequency, duration, character, severity, location, quality, and triggering, aggravating, and alleviating features. Age of onset is extremely important, and a family history of headache should be explored. Lifestyle features including diet, caffeine use, sleep habits, work, and personal stress are important to obtain. Finally, details of any comorbid conditions, such as an associated sleep disorder, depression, anxiety, and an underlying medical disorder are also useful.
The examination in headache is based on the general neurologic examination. Additional features include examination of the superficial scalp vessels, neck vessels, dentition and bite, the temporomandibular joints, and cervical and shoulder musculature. Pericranial muscle tenderness is thought to be an important physical finding in the diagnosis of tension-type headache[18].
DIAGNOSTIC EVALUATION
A. Headache occurring on ≥15 days per month on average for >3 months (≥180 days per year), fulfilling criteria B-D.
B. Lasting hours to days,or unremitting
C. At least two of the following four characteristics:
- Bilateral location
- Pressing or tightening (non –pulsating) quality
- Mild or moderate intensity
- Not aggravated by routine physical activity such as walking or climbing stairs
D. Both of the following:
- No more than one of photophobia,phonophobia or mild nausea
- Neither moderate or severe nausea nor vomiting
- Not better accounted for by another ICHD-3 diagnosis[3]
TREATMENT APPROACH
The conventional mode of therapy applied
Psychological treatment–
- Relaxation training-The goal of relaxation training is to help the patient to recognise and control tension as it rises in the course of daily activities .
- EMG biofeedback-The aim of EMG biofeedback is to help the patient to recognise and control muscle tension by providing continuous feedback about muscle activity.
- Cognitive behavioural therapy-The aim is to teach the patients to identify thoughts and beliefs that generate stress and aggravate headaches.
Physical therapy– it includes improving posture,relaxation,exercise programs hot and cold packs,ultrasoundand electrical stimulation[19].
Progressive muscle relaxation and deep breathing exercise – a randomized control trial wasconducted to assess the effectiveness of progressive muscle relaxation and deep breathing exercises on pain ,disability and sleep quality among patients with chronic tension type headache.here 169 patients were randomly selected ,out of which 84 performed the intervention and reported less pain severity and disability and better sleep quality after 12 weeks[13].
Prophylactic pharmacotherapy is considered in patients with a headache on more than 15 days per month i.e in patients with chronic tension type headache.tricyclic antidepressants amitriptyline,antidepressants,NSAIDS,muscle relaxants anticonvulsants and botulinum toxin have been tested in CTTH[19].
HOMOEOPATHIC PERSPECTIVE
John H.Clarke. – Clinical Prescriber
Headache of dull pressing in the forehead, incapacitating from mental labour. Pain like a heavy weight at the top of the head, intolerance of light and sound. Headache from loss of sleep,mental strain, worry, aching at occiput. Chronic Headache with sensitiveness to noise and light[10].
Subrata Kumar Banerjea
The syphilitic headache – is dull,heavy and persistent.It can often last for days at a time and is so severe as to be unendurable.These feelings may be accompanied by a sensation of bands around the head,a trait also shared by the tubercularmiasm.
Tubercular headaches- areperiodic,can be very severe and are sometimes accompanied with a sensation ofbands around the head[11].
John H. Clarke, M.D. in THE PRESCRIBER:
Headaches from loss of sleep mental strain,worry,occiput,Act.r.3,2h.Chronic headache ,with sensitiveness to pressure,noise,motion and light Silic.6,4h.Pressive drawing pains in the head,intolerable,<when attention is directed to them.Cham.6,2h[10].
HOMOEOPATHIC MANAGEMENT
The selection of similimum depends on the totality which variesfrom one person to another so we must stress on the individuality. The well known drug is basically used on totality but rare medicines are used when totality is not properly formulated. Paucity of symptoms in the remedies compels to use them on the basis of few indicated symptoms. This information is the base for use of the medicine. One should add some other symptoms which will be more useful to gather more information about the medicine.
From the perspective of choosing a homoeopathic remedy the type of headache is not the crucial factor – it is more important to match the symptoms of the headache to the traditional remedy picture.
REMEDIES
BELLADONNA –Headache of Throbbing ,shootingtype,driving the patient almost wild,the patient cannot lie down ,must sit up,nor can he bear light,a draft of air,noise.better by pressure and semi erect posture[16].
NUX VOMICA– We have the headache from the excessive use of alcohol ,the ache is usually situated on the left side.It is apt to begin in the morning with giddiness on first rising,and last all day until night,and is accompanied with sour taste or perhaps nausea and violent retching.
Worse by-Stooping and coughing , in the morning,moving the eyes and motion in general.
Better by-wrapping the head up warm and by rest[17].
GELSEMIUM-Headcahe due to eye strain.There is a feeling as if a band were about the head, the patient is dull and apathetic.Pain in temple extending into ear and wing of nose ,chin,better by compression and lying with head high[16].
CIMICIFUGA– It corresponds to headache of students and those exhausted by fatigue.There is a first sensation as if the the top of the head would fly off,there are sharp lancinating pain in and over the eyes ,shooting to the top of the head,better by bending head forwards[17].
EPIPHEGUS VIRGINIANA– Headaches brought on by over exertion,shopping,excitement,etc.worse by left side pressing on temple,better by rest and lying down[17].
LYCOPODIUM CLAVATUM – Pain in temples as if they were screwed towards each other ,brought on by not eating regularly,better by fresh air[16].
IRIS VERSICOLOR – for throbbing headaches that occur on one side of the head, especially after eating sweets; visual disturbances may also occur; these headaches are worse in the early morning, during spring and fall, and symptoms tend to worsen with vomiting.
CONCLUSION
In most people Tension Headache attacks and repeats over and over again as this disturbs the normal activity and produces uneasiness and other misery. As we know that it will be provocated by different exciting factors and hidden maintaining cause. So our obligation is to remove the cause and effect will be removed automatically.
Homoeopathy plays the important role for these type of affection. Large number of medicines which have been proved and verified frequently in healthy human beings by which we can depend on the medicines as these are clinically verified. From the perspective of choosing a homoeopathic remedy the type of headache is not the crucial factor it is more important to match the symptoms of the headache to the traditional remedy picture.
There are very less references of systematic research available proving the efficacy of Homoeopathy with constitutional approach in Tension type headache . There is a paucity of Randomised controlled studies in this regard Hence the current literature search is a sincere effort to explore the virtue of homoeopathy effectively.
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AUTHORS
Dr. Shweta B. Nanjannavar MD(HOM)
Dr. Poojarani.H.Adoni (PG Scholar)
A.M Shaikh homeopathic medical college and hospital. Belagavi,Karnataka.
Email : nanjannavarshweta@gmail.com, Poojaraniadoni@gmail.com
