Tension type headache : TTH is regarded as an extremely common headache in the general medicine, and TTH is diagnosed in most by the headache not to be caused by alcohol and the common cold that are not serious.
TTH is the most common headaches in a primary headache statistically, but the prevalence greatly varies by an investigation.
Chronic TTH surely greatly reduce quality of life and are serious disease to cause severe disorder so that the comment of the tension–type headache in ICHD–3 beta has it. In addition, frequent episodic TTH will be to have possibilities to affect as the treatment with a sometimes expensive drug is required.
However, Infrequent episodic TTH occurs in all most population, and when effect to give to an individual is very few things namely a physiological response.
I would like to describe a personal opinion about the way of a diagnosis of TTH in ICHD–3 beta and the classification.
Overview of the board–certified systems for Neurology, Stroke Medicine, Epilepsy, Headache and Dementia research in Japan are described. Perspective of Japanese Society of Neurological Therapeutics is also commented.
JES has certified the eligible members as clinical specialists of epilepsy since 1999, once they fulfill the qualification conditions and pass the examination (written– and oral part) that is currently done once a year in summer.
The Japanese Medical Specialty Board, formerly the Japanese Board of Medical Specialties, has approved it. Out of about 3000 JES members, a total of 633 members have been certified as clinical specialists of epilepsy until 2017. (http://square.umin.ac.jp/jes/en/clinical-sp.html)
症例は62歳男性．突然の眼痛で発症．強膜炎およびmyeloperoxidase anti–neutrophil cytoplasmic antibody（MPO–ANCA）陽性であり，ANCA関連血管炎が疑われた．Prednisolone（PSL）で治療されたが，MPO–ANCA上昇に伴い頭痛，左顔面感覚障害，嚥下時違和感が出現し，さらに左混合性難聴，間質性肺炎を合併し，顕微鏡的血管炎と診断された．経過中，外耳道炎を併発し感染症が疑われ抗菌薬開始とPSLが減量されたが，それに伴い滲出性中耳炎を認め，その後左三叉神経第1枝，第2枝，左顔面神経，左聴神経，左舌咽神経，左副神経，左迷走神経と左側のみの多発脳神経障害が出現した．頭部造影magnetic resonance imaging T1強調画像及び頭部computed tomographyで左内頚動脈錐体部から海綿静脈洞部，側頭骨，乳突蜂巣に骨破壊を伴う肉芽腫を認め，ANCA関連中耳炎によるGarcin症候群と診断した．経静脈的免疫グロブリン大量療法，ステロイドパルス療法及び後療法としてPSL 50mgを投与し，肉芽腫は縮小し症状は改善した．近年，ANCA関連血管炎に中耳炎を合併することが報告されており，ANCA関連血管炎性中耳炎（otitis media with ANCA associated vasculitis：OMAAV）として提唱されている．本症例はOMAAVに多発脳神経麻痺を合併した症例と考えられ，貴重であり報告した．