HEadaches

Question 1

What can cause Headaches to be chronic?

Answer 1

Increased excitability of the central nervous system generated by repetitive and sustained pericranial myofascial input may be responsible for the transformation of episodic tension-type headache into the chronic form

Peripheral activation or sensitization of myofascial nociceptors is most probably involved in the development of muscle pain and the acute episode of TTH. Repetitive episodes of muscle pain may sensitize the central nervous system resulting in progression of TTH to the chronic form

Increased tenderness to palpation of pericranial myofascial tissues is the most apparent abnormality in patients with tension-type headache.

Question 2

What is the nociceptive process?

Answer 2

It was concluded that the central pain sensitivity was increased in the patients probably due to sensitization of supraspinal neurones.

The increased nociceptive input to supraspinal structures may in turn result in supraspinal sensitization. The central neuroplastic changes may affect the regulation of peripheral mechanisms and thereby lead to, for example, increased pericranial muscle activity or release of neurotransmitters in the myofascial tissues.

By such mechanisms the central sensitization may be maintained even after the initial eliciting factors have been normalized, resulting in the conversion of episodic into chronic tension-type headache.

Question 3

What distinguishes migraines from tension headaches?

Answer 3

Strong genetic component

Migraine aura is defined as a focal neurological disturbance manifest as visual, sensory or motor symptoms. It is seen in about 30% of patients, and it is clearly neurally driven. The case for the aura being the human equivalent of the cortical spreading depression (CSD) of Leao has been well made.[15] In humans, visual aura has been described as affecting the visual field, suggesting the visual cortex, and it starts at the center of the visual field, propagating to the periphery at a speed of 3 mm/min.[16] This is very similar to spreading depression described in rabbits