Differentiated approach to the treatment of chronic migraine and tension-type headache
Objective. To develop the risk criteria of chronic headache and treatment algorithm for chronic migraine and tension-type headache considering comorbidities and data of molecular genetic examinations. Material and methods. The study included 56 patients with CM and chronic TTH meeting the ICHD-3criteria for CM. We used situational anxiety scale, HIT-6, express questionnaire for vertigo type, VAS scale, McGill pain questionnaire, vestibulometry with functional tests, stabilography with functional tests, neuro-orthopedic testing, esthesiometry, brain MRI to exclude secondary headache and molecular genetic examinations. Results. There was high incidence of benign paroxysmal positional vertigo (n=35, 81%) and vestibulovegetative complaints by the type of motion sickness (n=38, 88%) (χ2=25.58, p=0.0001). Thirty-nine (70%) patients with vertigo paroxysms had previous statokinetic disorders. We found decrease in pain sensitivity thresholds in patients with CM and chronic TTH. Functional blockages of vertebral-motor segment in cervical, thoracic and transitional spinal zones were revealed in all patients. We distinguished molecular genetic risk factors of chronic TTH and CM. An algorithm for choosing the treatment of CM and chronic TTH based on clinical, instrumental and molecular genetic data has been developed. Conclusion. Introduction of treatment algorithm for patients with CM and chronic TTH into practical healthcare will improve the effectiveness of treatment via a personalized approach to therapy considering comorbidities and molecular genetic data.