Ömer KARADAŞ, Avni BABACAN, HAKAN LEVENT GÜL, İlker Hüseyin İPEKDAL, Ülkü Türk BÖRÜ

Epizodik gerilim tipi başağrısının başarılı tedavisinde perikraniyal kasların rolü

Amaç: Gerilim Tipi Baş Ağrısının (GTBA) gelişiminden periferal ve santral nosiseptif mekanizmalar sorumlu tutulmaktadır. GTBAnın akut tedavisinde sıklıkla analjezikler, koruyucu tedavisinde ise antidepresanlar kullanılmaktadır. Bu çalışmada, Epizodik Gerilim Tipi Baş Ağrılı (EGTBA) hastalarda lokal lidokain uygulamasının tedavi edici etkinliği araştırıldı. Gereç ve Yöntem: Çalışmamıza perikranial hassasiyeti bulunan 20 EGTBAlı hasta (Grup 1) ile perikranial hassasiyeti bulunmayan 20 EGTBAlı hasta (Grup 2) alındı. Her iki gruptaki hastalara üç seans lokal %1lik lidokain enjeksiyonu uygulandı. Hastaların her birine iki taraflı olmak üzere frontal kaslara, temporal kaslara, masseter kaslarına, sternokloidomastoid kaslara, semispinalis capitis kaslarına, splenius capitis kaslarına ve trapezius kaslarına 1er ml enjeksiyon uygulandı. Hastaların tedavi öncesi ve tedavi sonrası 1. 2. ve 3. aylarda değerlendirmeleri yapılarak, bir ay içerisindeki ağrılı gün sayıları ve ağrı şiddetleri Vizüel Analog Skala (VAS) olarak kaydedildi. Bulgular: Çalışmaya 11 erkek 29 kadın hasta alındı. Grup 1in yaş ortalaması 35.95±9.85 (18-53) yıl, Grup 2nin yaş ortalaması 34.85±10.04 (20-54) yıl idi. Gruplar arasında yaş ve cinsiyet ve tedavi öncesi ağrı sıklığı ve ağrı şiddeti açısından farklılık saptanmadı (p>0.05). Lokal lidokain uygulanan perikranial hassasiyeti bulunan EGTBAlı hastaların hem ağrı sıklığı hem de ağrı şiddeti 1., 2. ve 3. ay kontrollerinde lokal lidokain uygulanan perikranial hassasiyeti bulunmayan EGTBAlı hastaların aynı dönemdeki ağrı sıklığından ve ağrı şiddetinden istatistiksel olarak anlamlı derecede daha düşük olduğu saptandı (p

The role of pericranial muscles in the succesful management of episodic tension type headache

Objectives: Peripheral and central nociceptive mechanisms are responsible for the development of Tension Type Headache (TTH). Analgesics are frequently used in the treatment of acute TTH. Antidepressants are used in prevention. In this study, the therapeutic efficacy of local application of lidocaine was investigated in Episodic Tension Type Headache (ETTH) patients. Methods: ETTH patients with pericranial tenderness (n=20, Group 1) and without pericranial tenderness (n=20, Group 2) were included in our study. Three sessions of local injection of 1% lidocaine were performed in both groups. Two-sided intramuscular injections of 1 mL were applied for each patient. The muscles treated were the frontal, temporal, masseter, sternokloidomastoid, semispinalis capitis, splenius capitis and trapezius muscles. Patients were evaluated in 1st, 2nd, and 3rd months. The number of painful days per month and pain intensities were recorded according to Visual Analog Scale (VAS) before and after the treatment. Results: 11 male and 29 female patients were included in the study. The mean ages of Group 1 and Group 2 were 35.95±9.85 (18- 53) and 34.85±10.04 (20-54) years, respectively. There was no difference between the groups in terms of age, gender, pain frequency and pain intensity (p>0.05). The frequency and severity of pain was significantly lower in pericranial-sensitive ETTH patients at the 1st, 2nd, and 3rd months after local lidocaine injections compared to ETTH patients having pericranial tenderness (p<0.05). Conclusion: Local lidocaine application can be used as an effective method in the treatment of ETTH patients with pericranial tenderness.

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