Stepanchenko K. Tension-type headache in adolescents: mechanisms of formation, course, treatment, prognosis

The prevalence and structure of tension-type headache (TTH) in an organized population of adolescents in Kharkiv city (Ukraine) have been studied. It has been shown that in the structure of all headaches, TTH is more common especially its episodic forms. Clinical and neurophysiological features of TTH have been analyzed from the position of dysfunction of cerebral regulatory non-specific systems through a comprehensive study of HRV and bioelectric activity of the brain, using the visual, spectral and nonlinear multidimensional EEG analyses. The value of irritation of supra-segmental cerebral structures with their subsequent insufficiency, activation of limbic structures, insufficiency of the synchronic thalamocortical system and relative activation of reticulocortical system, formation of stable pathological dominant in limbic structures are shown in the formation of chronic TTH. According to a number of clinical, neurophysiological and psychological indicators, the effectiveness of the method of individual adaptive biocontrol (MIAB – biofeedback) based on HRV in the adolescents with TTH is presented. It has been shown that in adolescents with episodic forms of TTH the effectiveness of MIAB is the same as pharmacotherapy and in patients with chronic TTH the most rational appointment is complimentary treatment (pharmacotherapy+MIAB). Prognostic tables have been developed. It’s revealed that the main risk factors for the development of TTH in adolescents are hereditary headache, pathology of the perinatal period, concomitant pathology (increased excitability, sleep disturbance, psycho-vegetative syndrome and diseases of the gastrointestinal tract), difficult adaptation to pre-school and school, unfavorable family factors, hypodynamia, smoking and alcoholic consumption. The pathogenetic concept of tension-type headache chronification, the treatment strategy and prophylaxis are proposed in the dissertation.