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Case Background
The patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache. She states that this is the sixth time she has had this headache in the last two months. She says the headaches last 2–3 days and have impacted her ability to concentrate at work. She complains of nausea and has vomited thrice in the previous 3 hours. She states, “The light hurts my eyes.” She rates her pain as a 10/10 at this time. Ibuprofen and acetaminophen ease her symptoms somewhat but do not relieve them. No other current complaints.
Neurological and Musculoskeletal Pathophysiologic Processes
Right-sided headache results from prolonged tension of the skeletal muscles of the head and neck due to the patient’s anxiety. Prolonged muscle spasm is manifested by pain in the form of a feeling of compression, tightening, or a feeling of a helmet. Increased muscle tension leads to narrowing of large arterial vessels, the development of ischemia, and increased discomfort (Bentivegna et al., 2021). Violation of blood flow is accompanied by venous stagnation, and thus a vicious circle arises. The muscle is insufficiently supplied with blood; due to its tension, metabolic products accumulate in it, which cannot be adequately excreted through the venous network, while the muscle becomes edematous and painful.
The role of trigger phenomena in the musculoskeletal system, as well as the participation of the peripheral component in the occurrence of headaches, is considered indisputable. Activation of nociceptors of anatomical formations of the vertebral column, muscles and tendons, vertebral arteries, roots, and nerve trunks represents a single functional system (Bentivegna et al., 2021). The different participation of each of the links could explain many symptoms of the pain of cervicocranial localization. Considering the important role of the myotonic syndrome in the pathogenesis and synchronization of headaches, the effect on excessively tense epicranial muscles is a priority in the complex therapeutic measures.
Racial and Ethnic Variables
Different ethnic groups (races) with a high degree of probability suggest the presence of genetic differences. Genetic polymorphism has a pronounced population dependence. At the same time, a wide range of genetic variations in ethnic groups and the presence of significant genetic differences between the main ethnic groups were revealed (Puntillo et al., 2021). The specificity in the distribution of frequencies of alleles and genotypes of the studied genes in representatives of different ethno-territorial groups of the population suggests the presence of features in the structure of susceptibility and prevalence of various multifactorial diseases in them.
At the heart of the headache, a significant role is played by the presence of chronic emotional stress. It is formed under the influence of individually significant psychogenic factors in persons with certain personality characteristics and insufficiency of psychological defense mechanisms, as well as functional insufficiency of antinociceptive systems (Puntillo et al., 2021). These disorders involving limbic systems and stem nociceptive systems lead to the emergence of autonomic-endocrine and psychomotor activation. Then it is manifested by increased muscle tone, ischemia, edema, and biochemical manifestations in the muscle tissue.
How These Processes Interact to Affect the Patient
The interaction of ethno-racial factors and neurological and musculoskeletal pathophysiological processes is observed because patients may have a certain tendency to several genetic structures. It is necessary to note the significant influence of the trigeminovascular and trigeminocervical complex in forming various types of headaches (Steel et al., 2021). The great occipital nerve may be a trigger structure that generates pain in the frontotemporal region. The afferent fibers of the three upper cervical roots converge to the same cells of the spinal cord horns, where the collaterals of the afferent fibers of the trigeminal nerve enter (Steel et al., 2021). Thus, it is assumed that the stimulation of the receptor field causes the interest of the trigeminal nerve system with clinical manifestations in its area of responsibility. According to the traditional view, the headache of muscle tension is objectified by an increase in the potentials of the electrical activity of the muscles of the soft integuments of the head on an electromyogram (Steel et al., 2021). The persistence of headaches makes patients irritable, and they do not tolerate loud sounds, bright lighting, and memory and performance decrease.
References
Bentivegna, E., Luciani, M., Paragliola, V., Baldari, F., Lamberti, P. A., Conforti, G., Spuntarelli, V., & Martelletti, P. (2021). Recent advancements in tension-type headache: A narrative review.Expert Review of Neurotherapeutics, 21(7), 793–803. Web.
Puntillo, F., Giglio, M., Paladini, A., Perchiazzi, G., Viswanath, O., Urits, I., Sabbà, C., Varrassi, G., & Brienza, N. (2021). Pathophysiology of musculoskeletal pain: A narrative review.Therapeutic Advances in Musculoskeletal Disease, 13, 1759720X2199506. Web.
Steel, S. J., Robertson, C. E., & Whealy, M. A. (2021). Current understanding of the pathophysiology and approach to Tension-Type headache.Current Neurology and Neuroscience Reports, 21(10). Web.
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