265: Psycho-Emotional and Neurophysiological Mechanisms of Tension-Type Headache in Adolescents

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary headache, Psychology, Non-pharmacological treatments, Electrophysiology/Clinical neurophysiology (e.g. microneurography, EEG, MEG, OPMs, TMS)

Background and Aims: Pediatric Tension-Type Headache (TTH) presents a significant socio-economic burden. In the studied Kharkiv population, headache prevalence reached 80.2%, yet specific psycho-emotional and autonomic triggers remain poorly understood. This study frames TTH as a clinical indicator of complex psycho-vegetative disorders. We aimed to increase diagnostic and therapeutic efficiency by investigating non-specific cerebral regulatory systems and identifying risk factors for chronification. This multidimensional approach addresses the gap in current pediatric neurology, moving toward a differentiated model of integrated bio-behavioral intervention and enhanced diagnostic accuracy for adolescent populations.

Methods: The study utilized a three-stage methodology: population screening (N=2342), clinical evaluation (N=320), and therapeutic intervention. Psychometric tools included Spielberger-Hanin for anxiety, Phillips for school anxiety, and Zhmurov for depression. Neurophysiological status was quantified via spectral and nonlinear EEG analysis and Heart Rate Variability (HRV). For the intervention phase, patients were randomized to evaluate the Method of Individual Adaptive Biocontrol (MIAB) - a biofeedback-based respiratory and relaxation training - against standard pharmacotherapy. Statistical validation employed the Bayes probabilistic method and Spearman correlation to assess quality of life (PedMIDAS) and therapeutic outcomes across randomized groups.

Results: Autonomic dysfunction occurred in 90.9% of subjects. Findings revealed that hyperthymic, anxiety, and cyclothymic traits correlate with TTH frequency. Reactive anxiety specifically correlated with headache intensity (VAS: r=+0.35, p<0.05). EEG data showed increased theta-activity, indicating limbic activation. Nonlinear analysis revealed reduced Kolmogorov-Sinai entropy in chronic cases, signifying an "information-poor state" and exhausted regulatory reserves. Furthermore, "learned pain behavior" stemming from negative parental educational models was identified as a key chronification factor. MIAB achieved 90%+ improvement in episodic cases, significantly reducing muscle-tonic syndromes and improving PedMIDAS scores compared to baseline.

Conclusions: Findings necessitate a shift from pharmacological-only models to integrated bio-behavioral paradigms. MIAB demonstrates efficacy comparable to standard drugs for episodic TTH, but combined therapy (Pharmacotherapy + MIAB) is superior for managing chronic cases. By addressing underlying neurophysiological dysfunctions without side effects, this integrated approach significantly improves Quality of Life. The developed evaluation-prognostic tables provide clinicians with essential tools for early risk identification. Implementing these strategies is critical for reversing pediatric pain chronification and enhancing the resilience of the adolescent nervous system through targeted, non-pharmacological cerebral regulation.

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Presenting Author: Kostiantyn Stepanchenko
Submitting Author: Kostiantyn Stepanchenko

Senior Author: Kostiantyn Stepanchenko

IASP 2026 Global Year theme of Neuropathic Pain: No