Chronic tension-type headache: clinical features of patients with comorbid conditions in different age groups

Background: 

Chronic tension-type headache (CTTH) is a common condition observed across various age groups. Comorbid arterial hypertension and psychoemotional disorders may influence the clinical course of the disease and reduce the effectiveness of therapy. However, age-related aspects of these interrelations remain insufficiently studied.

            Aim:  to determine the clinical characteristics of CTTH in relation to patient age and associated comorbidities( arterial hypertension(AH) and psychoemotional disorders).

            Methods:

A total of 97 patients diagnosed with chronic tension-type headache (ICHD-3, 2018) who consulted a neurologist between 2019 and 2023 were examined. A retrospective-prospective observational study with sequential sampling was conducted. No medical intervention was performed. Patients were divided into two age groups: Group I (18–44 years) and Group II (45–74 years). The following parameters were assessed: pain intensity (using the Visual Analog Scale), number of days with headache, dysfunction of pericranial muscles (DPM) during manual examination, triggering factors, presence of arterial hypertension (AH), and anxiety and depressive disorders (according to the Hamilton and Beck scales).. Statistical analysis was performed using SPSS 26.0, with significance level p<0.05.

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           Results: 

Arterial hypertension (AH )was identified in 32% of patients with CTTH: 9.6% in Group I and 57.7% in Group II (p < 0.001). Among patients aged 18–44 with AH, headache intensity was higher than in those without AH (p = 0.0463). In patients aged 45–74, the number of headache days was greater in those with AH compared to their peers without AH (p = 0.0281). Pericranial muscle dysfunction (PMD) was registered in 93.8% of participants, with a greater number of involved pericranial muscles observed in Group II (p = 0.042). Isolated involvement of a single muscle was more common among individuals aged 18–44 (p < 0.001). In young patients without comorbid AH, statistically significant involvement of the right trapezius muscle was identified (p = 0.029). In patients aged 45–74, regardless of the presence of AH, combined involvement of pericranial muscles was more frequent than isolated dysfunction (p = 0.019).

           Conclusion: CTTH in patients with  comorbid conditions (arterial hypertension, psychoemotional disorders) demonstrates age-related features, which justifies the need for personalized therapy.