Possibili fattori causali della cefalea di tipo tensivo. Uno studio caso-controllo

The IHS classification of headaches (1988) lists, at fourth digit code number for group 2, some 'most likely' causative factors of tension-type headache (TH). However, neither a cause-effect relationship nor a simple association between such factors and TH have so far been demonstrated. The aim of this study was to verify, by means of a case-control study on prevalent cases (patients referred to Pavia and Parma Headache Centres), the existence of an association between these factors (oromandibular dysfunction, psychosocial stress, anxiety, depression, somatic delusion or somatoform disorder, muscular stress, drug overuse) and TH. Fifty-one patients suffering from either episodic or chronic TH (cases) and an equal number of sex - and age - matched control subjects were studied. Fifty cases (98%) had at least one factor compared to 35 control subjects (69%: p(0.0001). Oromandibular dysfunction was diagnosed in 16 cases and 4 controls (OR: 5.4; CI: 1.5- 23.6), psychosocial stress in 9 cases and 12 controls (OR: 0.7; CI: 0.2- 2.0), anxiety in 41 cases and 18 controls (OR: 7.5; CI: 2.8-20.6), depression in 25 cases and 20 controls (OR: 1.5; CI: 0.6-3.5), somatoform disorder in 6 cases and 2 controls (OR: 3.3; CI: 0.5-34.3) muscular stress in 45 cases and 23 controls (OR: 9.1; CI: 3.1-30.2), drug overuse in 2 cases and 2 controls (OR: 1.0; CI: 0.1-14.3). Three of the seven 'most likely' causative factors of TH according to the IHS classification (oromandibular dysfunction, anxiety, muscular stress) were found significantly more prevalent in cases than in controls. The concurrent occurrence, in most cases, of more than one factor suggests a multifactorial etiology of TH.