Modern concepts about pathogenesis of the tension-type headache and mechanisms of development of the tension-type headache and arterial hypertension phenotype

Abstract

The aim of this review was to analyze domestic and foreign publications reflecting the main existing theories of tension-type headache (TTH) development and the search for common pathogenetic links of TTH with arterial hypertension (AH) as potential triggers for the development of the clinical TTH and AH phenotype.Methods. We searched for articles in databases (eLibrary.ru, Web of Science, Scopus, PubMed, Clinical Case) by keywords. Search depth – 2006–2021.Results. The analysis allowed us to identify the leading theories underlying the development of TTH: psychogenic, vascular, myofascial, biochemical and neurogenic. At the same time, a neurobiological theory has been considered: it combines some of the mechanisms of previously studied pathogenetic theories of TTH. In addition, there are the most important (from the clinical point of view) mechanisms of the comorbidity of TTH and AH, which underlie the development of the TTH + AH phenotype. In terms of these mechanisms, in recent years, it is of scientific interest to study the role of nitric oxide (NO) and NO-synthases, since they play an important role not only in the development of the comorbidity of two diseases simultaneously existing in one patient (phenotype «TTH and AH», but also in modulating the response to drugs for the treatment of TTH and AH. Modulators of NO and NO-synthases, which have been developed in recent years, can improve the efficacy and safety of therapy for this phenotype.Conclusion. New approaches to predicting and disease-modifying therapy of the TTH and AH phenotype can increase the efficiency and safety of treatment, and improve the quality of life of patients, and reduce the risk of cardiovascular complications.

New Genetic Biomarkers of the Overlap Syndrome Tension-Type Headache and Arterial Hypertension

“…A significance level (alpha) of 5% (0.05) and power (1-beta) of 90% (0.9) was used. The value of the expected frequency of the phenomenon in the main group (development of TTH in patients with AH, i.e., TTH and AH overlap syndrome) was 59.2% (taking into account our previous analysis [ 1 ]). The value of the expected frequency of the phenomenon in the control group (no headache in patients with AH) was 15.0% (also taking into account our previous analysis [ 1 ]).…”

“…Many studies support the hypothesis that TTH patients have a higher risk of developing AH, while hypertensive patients have a higher risk of developing TTH than in the general population. The relationship between TTH and AH is potentially of great pathophysiological and clinical interest as an overlap syndrome, but it is poorly understood [ 1 ]. This allows us to hypothesize the presence of the TTH and AH overlap syndrome [ 2 ].…”

“…However, according to epidemiological studies, the prevalence of TTH among hypertensive patients ranged from 33.4% to 85.0% [ 17 , 18 ], mean—59.2%, and the prevalence of migraine among hypertensive patients ranged from 15.0% to 66.6% [ 17 , 18 ], mean—40.8%. In general, the prevalence of TTH among patients with AH (TTH and AH overlap syndrome) was 1.45 times higher compared with the prevalence of migraine among patients with AH (migraine and AH overlap syndrome) [ 1 ].…”

Genetic Profiling of the Nitric Oxide Synthases’ System in a 55-Year-Old Woman with the Tension-Type Headache and Arterial Hypertension Phenotype: Case Report

“…Furthermore, NO is involved in nociceptive processing. A NO-induced biphasic response with immediate and a delayed headache is typical for chronic TTH in humans [3].…”

“…Many studies support the hypothesis that TTH patients have a higher risk of developing AH, while hypertensive patients have a higher risk of developing TTH than in the general population [2]. The relationship between TTH and AH is potentially of great pathophysiological and clinical interest as a clinical phenotype, but it is poorly understood [3,4].…”