STUDY OF PATHOGENETIC MECHANISM OF THE CHRONIC TENSION-TYPE HEADACHE

1Ekusheva E.V., 2Voitenkov V.B.
1Advanced Training Institute of the Federal Medical Biological Agency, Moscow, Russia
2Pediatric Research and Clinical Center for Infectious Diseases, St-Petersburg, Russia

Background. Tension-type headache is the most common variant of cephalgia. There are unclear issues in the underlying mechanisms of the development and chronization of the chronic tension-type headache (CTTH). Objective. Our objective was to study the pathogenesis of the CCTH. Methods. 84 patients (age 39.2±6.1 years) with CTTH and 25 healthy controls were enrolled. Clinico-neurological examination, nociceptive flexor reflex (RIII reflex), blink reflex, and transcranial magnetic stimulation were performed. All patients were examined before the therapy with drugs with proven efficacy taken at therapeutic doses for three months. After the treatment all patients were divided into 2 groups: 1 with a good response to the therapy (decrease in frequency and intensity of headache) and 2 with minimal effect/its absence. Results. A comparative neurophysiological analysis of the data obtained in patients before the course of preventive treatment, showed significant differences between them with significantly greater reduction in pain threshold (6.3±4.1) and pain threshold/threshold reflex (0.78±0.12) - RIII reflex; significantly greater decrease in threshold of R3 (7.9±2.3) and disruption of component's sensitivity to blink reflex in 2 group comparison with other subjects (р0,01). Activation of the central links of nociception in patients of the second group was indicated by decrease in the thresholds of MEPs (42.3±3.3 on the right and 41.7± 2.3 on the left, respectively) compared with 1 group (47.6±2.5 on the right and 47.2±2.1 on the left, respectively) and controls (respectively 49.2±3.1 on the right and 48.6±2.5 on the left). Conclusion. Our study of patients with CTTH showed significant violations of integral mechanisms of pain control in patients with low efficacy of standard preventive therapy or its absence. This calls to the neurophysiological examination prior to the treatment and the possible use of anticonvulsants on hyperexcitability of neurons of the motor cortex in CTTN cases.
 

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