RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE& ADDRESS / : MS. SHALINI. T
: I YEAR M. Sc NURSING
GOVENRNMENT COLLEGE OF
NURSING, HASSAN.
2. / NAME OF THE INSTITUTION / : GOVENRNMENT COLLEGE OF
NURSING, HASSAN.
3. / COURSE OF THE STUDY
& SUBJECT / : I YEAR M. Sc NURSING
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION / : 29TH JULY 2013
5. / TITLE OF THE TOPIC / : EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME ON KNOWLEDGE AND KNOWLEDGE ON PRACTICE REGARDING PREVENTION AND MANAGEMENT OF TENSION TYPE HEADACHE AMONG EMPLOYEES OF BHARATH SANCHAR NIGAM LIMITED (BSNL) AT HASSAN .
6. BRIEF RESUME OF THE INTENDED WORK
“Your pain matters, it is your guide to healing”
INTRODUCTION
The human being of the present era is running breathlessly behind his endless desires. To meet these desires, change of lifestyles has taken place which includes irregular faulty dietary pattern, suppression of natural urges, sleepless nights, no entertainment and inadequate time for relaxation. Consequently the man has become victim of challenging diseases like tension headache, hypertension etc.
Tension headache was renamed as Tension Type Headache (TTH) by the International Headache Society (IHS) in 19881 . Tension-type headache (TTH) is the most prevalent headache in the general population, and it is recognized by patient as Normal Headache. The typical presentation of a TTH attack is that of a mild to moderate intensity, bilateral, non throbbing headache without other associated feature2.
According to modern science, headache is an extremely common phenomenon, experienced by most people, particularly in settings of stress and fatigue. Incidence of stress is increasing day by day due to the present life styles. Employees especially professionals are subjected to continuous physical and mental stress. Occupational stress occurs when there is discrepancy between demand of work place environment and individuals’ ability to carry out or complete the demand. It is expressed as dissatisfaction, fatigue, tension, headache, agitation, insomnia, sexual problems etc1.
A survey study was done on telephone operators and mobile operators, the study has shown that users of phone more often complaint of headache, fatigue, anxiety3. Tension headache is the most common type of headache. This type of headache can cause mild or moderate pain in the head,neck, and behind the eyes. Some patients say that a tension headache feels like a tight band around their foreheads since tension headaches are often caused by specific triggers, identifying the factors that cause headachesis one way to prevent future episodes4.
Tension headaches are so common, they effect on job productivity and overall quality of life is considerable, particularly if they're chronic. The frequent pain may render unable to attend activities and need to stay home from work, and job ability function is impaired1.
Even though advances have been made with regard to the treatment of acute migraine headaches and tension type headache (i.e., the triptan formulations), many patients often discontinue their interventions due to treatment dissatisfaction. Among individuals seeking treatment for tension-type headaches, the frequency of such headaches is often daily or almost every day. Unfortunately, chronic tension-type headaches are associated with analgesic abuse, and are difficult to manage in a primary care setting due to frequent analgesic use problems. Thus, it is imperative that other methods of treatment be researched and developed in order to increase satisfaction, therapeutic response, and compliance amongst these patients. Thus, cognitive-behavioral therapy will be most beneficial for the patient where affective distress play a major role, while biofeedback or relaxation training may be preferable for the tense patient with Tension Type Headache5.
6.1 NEED FOR THE STUDY
Tension-type headache (TTH) is the most commonly found headache in the general population and is one of the commonest reason people rush to the medical stores to purchase Analgesics. And when it is taken several times a day, it leads to drug dependency and withdrawal headache for which patients needs to take more and more Analgesics6.
A tension headache is the most common type of headache. This type of headache can cause mild or moderate pain in the head,neck, and behind the eyes. Some patients say that a tension headache feels like a tight band around their foreheads4.
Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population has chronic tension-type headaches 7. A cross sectional study was conducted by HeadacheCenter, Department of Clinical and Experimental Medicine, University of Parma, Ospedale Maggiore, via Gramsci Parma, Italy in the year may 2013 on Prevalence oftension-type headacheAmong adult general population in the city of paramas: the PACE (PArma CEfalea, or "Headachein Parma") Crude past-year prevalence for definite TTH was 19.4 % (95 % CI 16.8-21.9), namely 9.0 % (95 % CI 7.1-10.8) for infrequent TTH, 9.8 % (95 % CI 7.9-11.8) for frequent TTH, and 0.6 % (95 % CI 0.1-1) for chronic TTH. Crude prevalence for probable TTH was 2.3 % (95 % CI 1.3-3.3). The study concluded that TTH prevalence rate (19.4 %) at the lower limit of data ranges currently available8.
TTH is a relatively featureless headache, making it the least distinct of all the primary headache phenotypes, In addition, it is the least studied of all the primary headache disorders, despite having perhaps the highest total socioeconomic impact9.
Stress is a trigger for some people who develop tension-type headaches. Sometimes a stressful job or situation cannot be avoided. Learning to cope with stress and to relax may help. Breathing and relaxation exercises, or coping strategies, may ease anxiety in stressful situations and prevent a possible headache. There are books and tapes which can teach how to relax. Sometimes a referral to a counselor or psychologist may be advised 10.
Many people with chronic tension-type headache put up with their headaches without seeing a doctor. In one study, two-thirds of people diagnosed with chronic tension-type headache had daily or near daily headache for an average of seven years before consulting a doctor. Most continued to function at work or school, but their performance was often not as good as it could be. Almost half had anxiety or depression, possibly as a result of coping with their frequent headaches 10.
Tension headaches often respond to treatment and rarely cause permanent damage. However, chronic tension headaches can affect quality of life. These headaches may make it difficult to participate in physical activities11.
As tension headache is one the burning problem, I found many studies were done related to the topic but the study regarding the knowledge was inconsistent, so I was motivated to conduct this study.
6.2 REVIEW OF LITERATURE
Review of literature is a critical summary of research on the topic of interest generally prepared to put a research problem in proper context or to identify the gaps weakness on previous studies to justify a new investigation 12.
In this study Review of literature has been grouped under the following headings:
1. Incidence and prevalence of tension type headache;
2. Causes and precipitating factors of Tension Type Headache;
3. Burden and quality of life With Tension Type Headache;
4. Prevention and Management of Tension Type Headache;
1. INCIDENCE AND PREVELANCE OF TENSION TYPE HEADACHE
Cross sectional study was conducted by Department of Neurology, Jondishapour Neurology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, to evaluate the prevalence rates of different types ofheadacheamong adult population of Tehran urban area in the year 2010 After enrollment, participation rate of 91% (3,655 out of 4,000) was achieved. Of 3,655 recruited individuals, 2,778 (76%) people have experiencedheadachewithin last year.Tension-type headacheand migraine were the most common types with the prevalence of 48.6% (n = 1,777) and 18.2% (n = 665), while, chronic daily, medication overuseheadacheand cluster headaches were presented in 7.0% (n = 255), 4.9% (n = 180) and 0.1% (n = 3), respectively. The prevalence of primary headaches in a sample of Tehran adult population is considerable. Study concluded that the high prevalence of headaches necessitates further evaluation of possible risk factors derived from leaving in such a crowded metropolitan area 13.
A cross sectional study was conducted by HeadacheCenter, Department of Clinical and Experimental Medicine, University of Parma, Ospedale Maggiore, via Gramsci Parma, Italy in the year may 2013 on Prevalence oftension-type headacheAmong adult general population in the city of paramas: the PACE (PArma CEfalea, or "Headachein Parma") Crude past-year prevalence for definite TTH was 19.4 % (95 % CI 16.8-21.9), namely 9.0 % (95 % CI 7.1-10.8) for infrequent TTH, 9.8 % (95 % CI 7.9-11.8) for frequent TTH, and 0.6 % (95 % CI 0.1-1) for chronic TTH. Crude prevalence for probable TTH was 2.3 % (95 % CI 1.3-3.3). The study concluded that TTH prevalence rate (19.4 %) at the lower limit of data ranges currently available for Western countries, and prevalence rates for infrequent forms (9 %) do not appear much different from those of frequent forms (9.8%) 8.
2. CAUSES AND PRECIPTATING FACTORS
A cross sectional study was conducted by specializedheadacheclinic in Dept. of Neurology, Dhaka Medical College Hospital Bangladesh in august 2012 on Precipitating and relieving factors of migraine versustension type headache among 250 migraine and 250 tension headache patients from a specialized headache clinic . Data were collected through a predesigned questionnaire containing information on age, sex, social status and a predetermined list of precipitating and relieving factors. In this study, the female patients predominated (67%). Most of the patients were within 21-30 years age group (58.6%). About 58% of them belonged to middle class families. Significant difference was demonstrated for fatigue (p < 0.05), sleep deprivation (p < 0.05), sunlight (p < 0.01) and food (p < 0.05), which were common among migraineurs. In consideration of relieving factors of pain study concluded that The most frequent precipitating factors forheadacheappear to be identical for both migraine and TTH patients. Even though some factors like fatigue, sleep deprivation, sunlight and food significantly precipitate migraine and drug, massage are effective maneuver for relieving pain among migrianeurs 14.
Survey was conducted by Physics Department, Faculty of Arts and Sciences, Celal Bayar University , Manisa , Turkey on Self-reported symptoms associated with exposure to electromagnetic fields in the year June 2013 .The aim of the study was to explore different self-reported symptoms that may be associated with exposure to electromagnetic fields. This survey study was conducted, using a questionnaire, on 350 people aged +9 years in Turkey. The chi-square test was used for data analysis the study concluded that the study has shown that users of mobile phone and computer more often complained ofheadache, joint and bone pain, hearing loss, vertigo/dizziness,tension-anxiety symptoms according to time of daily usage (p < 0.05). In users of mobile phone and computer, women significantly (p < 0.05) complained more often ofheadache, vertigo/dizziness, fatigue, forgetfulness andtension-anxiety than men 3.
3. BURDEN AND QUALITY OF LIFE
A community-based survey was done by department of epidemiology, National Institute of Mental Health and Neurosciences, Bangalore, India in the year October 2012 on the burden of headache disorders in India in the adult Indian population in urban and rural areas in and around Bangalore, Karnataka state. from 2,714 households contacted, 2,514 biologically unrelated individuals were eligible for the survey and 2,329 (92.9 %) participated (1,103 [48 %] rural; 1,226 [52 %] urban; 1,141 [49 %] male; 1,188 [51 %] female; mean age 38.0 years). the focus was on primary headache (migraine and tension-type headache [tth]) and medication-overuse headache. the study concluded a high values (> 80 %) for sensitivity, specificity and predictive values for any headache, and for specificity and negative predictive value for migraine and tth. kappa values for diagnostic agreement were good for any headache (0.69 [95 % ci 0.61-0.76]), moderate (0.46 [0.35-0.56]) for migraine and fair (0.39 [0.29-0.49]) for tth. the survey methodology, including identification of and access to participants, proved feasible. the questionnaire proved effective in the survey population. the study will give reliable estimates of the prevalence and burden of headache, and of migraine and TTH specifically, in urban and rural Karnataka 15.
A pilot study was conducted by Universidad rey juan carlos, espana , in august 2012 on Myofascial trigger points, pain, disability and quality of sleep in patients with chronictension-type headache . study was done to determine the relationship between Myofascial trigger points , intensity of pain, disability and quality of sleep in people with chronictension-type headache Participants in the study consisted of 16 patients with chronictension-type headacheand 15 healthy controls. A visual analogue scale was used to measure the intensity of the pain, and the neck disability questionnaire and the Pittsburgh (quality of sleep) questionnaire were also employed. The subjects with chronictension-type headachehad greater cervical disability (p < than the controls, whereas the quality of sleep showed a tendency (p = 0.092). A positive correlation was found between the worst pain last week with the Pittsburgh questionnaire (r =0.631; p = 0.009) and disability (r = 0.521; p = 0.046), as well as a positive correlation between disability and quality of sleep (r = 0.815; p < 0.001). The study concluded Quality of sleep and active MTP can be different factors contributing to chronictension-type headache. Nevertheless, the presence of MTP could also be an epiphenomenon of the pain 16.
4. PREVENTION AND MANAGEMENT OF TENSION TYPE HEADACHE
An observational study was conducted by Charly Gaul, Christina van Doorn, and Günther Fritsche in the year 2011 on Clinical outcome of a headache-specific multidisciplinary treatment program and adherence to treatment recommendations in a tertiary headache center The study investigated the outcome of a 5-day headache-specific multidisciplinary treatment program (MTP) and the adherence to treatment recommendations in 295 prospectively recruit Adherence to non-pharmacological and behavioral treatment. recommendations was associated with a better outcome. consecutive headache patients for the study was [210 migraine, 17 tension-type headache (TTH), 68 combination headache, including 56 medication-overuse headache (MOH)]. Increasing number of headache days per month (OR=1.092,p≤0.0001) and adherence to lifestyle modifications (OR=1.269,p=0.004) predicted primary outcome. 51 of 56 MOH patients were treated successfully. Thirty-five percent of the patients were adherent to pharmacological prophylaxis, 61% to relaxation therapy, and 72% to aerobic endurance sports. The study concluded that MTP is effective in headache treatment. Adherence to therapy was associated with better outcome. The MTP seems to be an effective approach in the treatment of frequent migraine, TTH, and MOH 17.