"Recent Tension headache publications are scanned daily from major neurology journals and updated here"
December 2007 archive of tension headache therapy:-
Body mass index and episodic headaches: a population-based study. Related Articles
Body mass index and episodic headaches: a population-based study.
Arch Intern Med. 2007 Oct 8;167(18):1964-70
Tension headache research :- Authors: Bigal ME, Tsang A, Loder E, Serrano D, Reed ML, Lipton RB
BACKGROUND: We investigated the influence of the body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) on the frequency, severity, and patterns of treatment of migraine, probable migraine (PM), and severe episodic tension-type headache (S-ETTH). METHODS: A validated questionnaire was mailed to 120 000 households selected to be representative of the US population. The participants were divided into 5 categories based on BMI: underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), obese (30.0-34.9), and morbidly obese (>35.0). Analyses were adjusted by covariates that included demographic variables (age, sex, race, and income), duration of illness, comorbidities, use of preventive medication, and use of opioids. RESULTS: The response rate was 65%. We identified 18 968 individuals with migraine, 7564 with PM, and 2051 with S-ETTH. The distribution of very frequent headaches (10-14 d/mo) was assessed by BMI. Among individuals with migraine, very frequent headaches (10-14 d/mo) occurred in 7.4% of the overweight (P = .10), 8.2% of the obese (P < .001), and 10.4% of the morbidly obese (P < .0001) subjects, compared with 6.5% of those with normal weight, in adjusted analyses. Among individuals with PM and S-ETTH, the differences were not significant (P = .20). The disability of migraineurs, but not of those with PM or S-ETTH, also varied as a function of BMI. Among migraineurs, 32.0% of those with normal weight had some disability compared with 37.2% of the overweight (P < .01), 38.4% of the obese (P < .001), and 40.9% of the morbidly obese (P < .001) subjects. CONCLUSION: These findings support the concept that obesity is an exacerbating factor for migraine but not for other types of episodic headaches.
Tension headache research :- PMID: 17923596 [PubMed - indexed for MEDLINE :- Tension headache research]Headache (chronic tension-type). Related Articles
Headache (chronic tension-type).
Am Fam Physician. 2007 Jul 1;76(1):114-6
Tension headache research :- Authors: Silver N
Tension headache research :- PMID: 17668850 [PubMed - indexed for MEDLINE :- Tension headache research]Prednisolone does not reduce withdrawal headache: a randomized, double-blind study. Related Articles
Prednisolone does not reduce withdrawal headache: a randomized, double-blind study.
Neurology. 2007 Jul 3;69(1):26-31
Tension headache research :- Authors: Bøe MG, Mygland A, Salvesen R
INTRODUCTION: Medication overuse headache is a condition where abrupt drug withdrawal is considered the treatment of choice. OBJECTIVE: To study whether prednisolone given orally the first 6 days after medication withdrawal reduces headache intensity during the same period. METHODS: From August 2003 through November 2005, we included patients aged 18 to 70 years with probable medication overuse headache. The study was randomized, double-blind, and placebo controlled. The patients were hospitalized for 3 days to start medication withdrawal. They were randomly assigned to receive prednisolone 60 mg on days 1 and 2, 40 mg on days 3 and 4, and 20 mg on days 5 and 6 (Group A) or placebo tablets for 6 days (Group B). Headache intensity was recorded in a diary for a month before withdrawal (baseline) and throughout the study period of 28 days. The primary endpoint was a calculated mean headache (MH), based on number of days with headache and mean intensity the first 6 days after withdrawal. RESULTS: We included 26 men and 74 women. Sixty-five had migraine, 13 had tension-type headache, and 22 had both migraine and tension-type headache. Baseline headache days were 25.4 (CI 24.3 to 26.4). Baseline MH was 1.6 (CI 1.41 to 1.69). Fifty-one received Regimen A, and 49 received Regimen B. Baseline features were similar. During the first 6 days after withdrawal, headache was similar in Groups A and B (MH 1.48 [CI 1.28 to 1.68] vs 1.61 [CI 1.41 to 1.82], p = 0.34). CONCLUSION: Prednisolone has no effect on withdrawal headache in unselected patients with chronic daily headache and medication overuse.
Tension headache research :- PMID: 17475943 [PubMed - indexed for MEDLINE :- Tension headache research]Peppermint oil. Related Articles
Am Fam Physician. 2007 Apr 1;75(7):1027-30
Tension headache research :- Authors: Kligler B, Chaudhary S
Peppermint leaf and peppermint oil have a long history of use for digestive disorders. Recent evidence suggests that enteric-coated peppermint oil may be effective in relieving some of the symptoms of irritable bowel syndrome. A combination product including peppermint oil and caraway oil seems to be moderately effective in the treatment of non-ulcer dyspepsia. Topical application of peppermint oil may be effective in the treatment of tension headache. Because of its relaxing effects on smooth muscle, peppermint oil given via enema has been modestly effective for relief of colonic spasm in patients undergoing barium enemas. Peppermint oil is well tolerated at the commonly recommended dosage, but it may cause significant adverse effects at higher dosages.
Tension headache research :- PMID: 17427617 [PubMed - indexed for MEDLINE :- Tension headache research]Postpartum headache: is your work-up complete? Related Articles
Postpartum headache: is your work-up complete?
Am J Obstet Gynecol. 2007 Apr;196(4):318.e1-7
Tension headache research :- Authors: Stella CL, Jodicke CD, How HY, Harkness UF, Sibai BM
OBJECTIVE: Headache is a common finding in the postpartum period, and there are limited data describing the cause and treatment of women with postpartum headache. Our objective was to describe our experience with women who were hospitalized for postpartum headache and to develop a management algorithm for these women. STUDY DESIGN: Data for 95 women with headache >24 hours after delivery from 2000-2005 were reviewed retrospectively. Maternal assessment included an evaluation for benign and serious causes of headache that included preeclampsia, dural puncture, and neurologic lesions. Neurologic imaging were performed on the basis of initial neurologic findings and clinical course. Outcomes that were studied included cause, a need for cerebral imaging, neurologic findings, maternal complications, and long-term follow-up evaluations. RESULTS: The mean onset of headache was 3.4 days (range, 2-32 days) after delivery. Tension-type/migraine headache was the most common cause (47%). Preeclampsia/eclampsia and spinal headache comprised 24% and 16% of cases, respectively. Anesthesia evaluation was required in 15 patients because of suspected spinal headache; blood patch was required in 12 of these patients. Cerebral imaging was performed in 22 patients because of focal neurologic deficits and/or failure to respond to initial therapy; 15 of these women (68%) had abnormal findings. Ten patients had serious cerebral pathologic findings, such as hemorrhage, thrombosis, or vasculopathy. There were no deaths; 2 women had minor residual neurologic damage on follow-up evaluation. CONCLUSION: The evaluation of persistent headaches that develop >24 hours after delivery must be performed in a stepwise fashion and requires a multidisciplinary approach. Preeclampsia should be considered initially in women with hypertension and proteinuria. Normotensive women should be evaluated initially for tension-type/migraine headache or spinal headache. Patients with headache that is refractory to usual therapy and patients with neurologic deficit require cerebral imaging to detect the presence of life-threatening causes.
Tension headache research :- PMID: 17403403 [PubMed - indexed for MEDLINE :- Tension headache research]Applying the International Classification of Headache Disorders to the emergency department: an assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation. Related Articles
Applying the International Classification of Headache Disorders to the emergency department: an assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation.
STUDY OBJECTIVE: Although almost 2 decades have passed since the International Headache Society first introduced its International Classification of Headache Disorders (ICHD), the applicability of this classification scheme in the emergency department (ED) has not been assessed. As a first step toward identifying the role the ICHD should play in the ED, we address 2 questions: Can a structured interview and adherence to the ICHD allow ED headache patients to be classified in a reproducible manner? With the ICHD, how often can one specific diagnosis be assigned to each ED headache presentation? METHODS: This was a structured interview and medical record review of patients with nontraumatic headache, performed in an urban ED from March 2004 through August 2005. Using the data from the interview and the subject's ED record, 2 emergency medicine investigators independently classified each of the headaches twice: first, to determine presence or absence of a primary headache disorder, and then to determine presence or absence of a secondary headache disorder. If a primary headache was present, it was further classified as migraine, tension-type headache, trigeminal autonomic cephalalgia, chronic daily headache, or primary headache unclassifiable. Interobserver discordance was adjudicated by an experienced headache specialist. RESULTS: Four hundred eighty patients were enrolled in the study. The emergency medicine investigators had a high level of interobserver agreement on secondary headaches (agreement 94% [95% confidence interval (CI) 92% to 96%]) and primary headaches (agreement 91% [95% CI 88% to 93%]). Among the 480 subjects, 122 (25%) had a secondary headache disorder, 309 (64%) had a primary headache disorder, 49 (10%) had a coexisting primary and secondary headache, and for 95 (20%) subjects, neither a primary nor a secondary headache could be diagnosed. Of 309 subjects with a primary headache, 186 (60%) had migraine, 34 (11%) had tension-type headache, 2 (1%) had trigeminal autonomic cephalalgia, and 77 (26%) had an unclassifiable primary headache. Overall, a specific ICHD headache diagnosis could not be assigned to 36% of subjects either because a specific primary headache disorder could not be identified or because neither a primary nor a secondary headache disorder could be diagnosed. CONCLUSION: Although a detailed structured interview in the ED and adherence to the ICHD resulted in reproducible classification of headache patients, more than one third of acute headache patients could not readily be given a specific ICHD diagnosis in the ED.
Tension headache research :- PMID: 17210203 [PubMed - indexed for MEDLINE :- Tension headache research]Outcomes and predictors of chronic daily headache in adolescents: a 2-year longitudinal study. Related Articles
Outcomes and predictors of chronic daily headache in adolescents: a 2-year longitudinal study.
Neurology. 2007 Feb 20;68(8):591-6
Tension headache research :- Authors: Wang SJ, Fuh JL, Lu SR, Juang KD
OBJECTIVES: To assess the outcomes and predictors of chronic daily headache (CDH) in a community-based cohort of adolescents. METHODS: We established a field sample of 122 adolescents (32 M/90 F, ages 12 to 14) with CDH in 2000. These adolescents received annual follow-up by neurologists for 2 years via a semistructured telephone interview. CDH was defined as > or =15 headache days/month, average > or =2 h/day for >3 months; subtypes were classified based on the original and appendix criteria of the International Classification of Headache Disorders (2nd ed.; ICHD-2). Poor outcome was defined as persistence of CDH at 2 years. RESULTS: Follow-up response rates were 92% in 2001 and 84% in 2002. Average monthly headache frequency was 11.0 +/- 9.7 days in 2001 and 7.7 +/- 6.5 days in 2002. CDH persistence rates were 40% in 2001 and 25% in 2002. Medication overuse declined from 20% (baseline) to 6% at 2 years. The prevalence of migraine did not change throughout the follow-up (67 to 60%), whereas that of tension-type headache deceased from 86 to 46% (p < 0.001). Chronic migraine prevalence increased markedly at baseline and became the most common CDH subtype at follow-up when using the ICHD-2 appendix criteria. During follow-up, seven subjects (6%) dropped out of school. Independent predictors for CDH persistence were medication overuse and major depression. CONCLUSIONS: Most adolescents with chronic daily headache (CDH) continued to have frequent headaches, although the incidence of CDH declined at follow-up. Migraine diagnosis gained prominence as headache frequency decreased. The percentages of chronic migraine in adolescents with CDH increased obviously if the appendix criteria were applied.
Tension headache research :- PMID: 17182975 [PubMed - indexed for MEDLINE :- Tension headache research]Adult patients with Eisenmenger syndrome report flying safely on commercial airlines. Related Articles
Adult patients with Eisenmenger syndrome report flying safely on commercial airlines.
Heart. 2007 Dec;93(12):1599-603
Tension headache research :- Authors: Broberg CS, Uebing A, Cuomo L, Thein SL, Papadopoulos MG, Gatzoulis MA
BACKGROUND: Despite fears of compromised oxygen delivery in patients with Eisenmenger syndrome during flight on commercial aircraft, a clinical study has shown no adverse effects, and many patients travel frequently. METHODS: The air travel history over the past decade of 53 patients with Eisenmenger syndrome and 48 acyanotic patients was obtained. Patients listed all flights and destinations, and any major adverse event or symptoms, including, specifically, headache, palpitations, oedema or need for supplemental oxygen. For the patients with Eisenmenger syndrome, a full blood count, 6-minute walk test and p50 of the oxygen-haemoglobin dissociation curve were also obtained. RESULTS: 1157 flights were reported evenly between the two groups. Thirteen patients with Eisenmenger syndrome reported no travel in the past 10 years (vs 4/48 acyanotic patients, p = 0.03), six of whom were told not to fly by healthcare providers. Of those who flew, the number and distance of flights was similar in both groups. No major adverse events were reported. One patient with Eisenmenger syndrome possibly had a transient ischaemic attack and a second patient needed supplemental oxygen when exposed to ambient cigarette smoke in flight. Other symptoms such as headache, palpitations and lower extremity oedema at the travel destination were reported with similar frequency in both groups. Patients with Eisenmenger syndrome had a raised p50 of the oxygen-haemoglobin dissociation curve (mean (SD) 29.4 (2.6) mm Hg vs 27 (3) mm Hg in laboratory controls, p<0.01). CONCLUSIONS: Patients with Eisenmenger syndrome report travelling frequently and safely on commercial airlines. Shifts in the oxygen-haemoglobin dissociation curve are likely to attenuate the effects of low oxygen tension. Patients with Eisenmenger syndrome should, nevertheless, be advised to avoid inactivity and dehydration as usual, but there is no justification for limiting air travel.
Tension headache research :- PMID: 17164484 [PubMed - in process]Prevalence of facial pain in 108 consecutive patients with paranasal mucopurulent discharge at endoscopy. Related Articles
Prevalence of facial pain in 108 consecutive patients with paranasal mucopurulent discharge at endoscopy.
J Laryngol Otol. 2007 Apr;121(4):345-8
Tension headache research :- Authors: Clifton NJ, Jones NS
We undertook a prospective observational study of 108 consecutive patients with endoscopic paranasal mucopurulent secretions. Only 31 patients (29 per cent) had facial pain. In 20 (65 per cent), the endoscopic site of purulent secretions corresponded to the site of pain. In those with facial pain, 74 per cent had nasal obstruction, 68 per cent had objective hyposmia and 84 per cent had mucopurulent rhinorrhoea. In the 31 patients with facial pain, 19 (61 per cent) became symptom free following medical treatment. The remaining 12 patients underwent surgery and their symptoms resolved, except for one patient with a tension-type headache and another with pain of unknown cause.Most patients with purulent secretions from the paranasal sinuses do not have facial pain; therefore, chronic rhinosinusitis is not synonymous with pain.Patients with sinogenic facial pain usually have endoscopic findings that correlate with the site of pain, and the majority also have other nasal symptoms. Chronic infective rhinosinusitis usually responds to medical therapy, and the remainder resolve with surgery.
Tension headache research :- PMID: 17156506 [PubMed - indexed for MEDLINE :- Tension headache research]Is any one analgesic superior for episodic tension-type headache? Related Articles
Is any one analgesic superior for episodic tension-type headache?
Though all non-narcotic analgesics have equivalent efficacy against tension-type headache, ibuprofen's generally favorable side-effect profile makes it a reasonable first choice.
Tension headache research :- PMID: 17137543 [PubMed - indexed for MEDLINE :- Tension headache research]Prognosis of migraine headaches in adolescents: a 10-year follow-up study. Related Articles
Prognosis of migraine headaches in adolescents: a 10-year follow-up study.
Neurology. 2006 Oct 24;67(8):1353-6
Tension headache research :- Authors: Monastero R, Camarda C, Pipia C, Camarda R
OBJECTIVE: To determine the long-term outcome of migraine headaches in adolescents and to identify possible predictors of prognosis. METHODS: Fifty-five of 80 subjects with migraine headaches (ages 11 to 14 years), who attended the baseline examination of a population-based study conducted in southern Italy in 1989, were eligible for follow-up in 1999. All interviews and examinations were conducted by neurologists, and migraine diagnoses were based on the International Headache Society (IHS) criteria. The association between possible prognostic factors and the long-term persistence of migraine headaches was explored using logistic regression analysis. RESULTS: Of 55 subjects with migraine headaches at baseline, 41.8% had persistent migraine, 38.2% had experienced remission, and 20.0% transformed to tension-type headache. Only migraine without aura persisted in the same IHS code after 10 years, whereas migrainous disorder and nonclassifiable headache did not. The family history of migraine significantly predicted the 10-year persistence of migraine headaches (odds ratio [OR] = 7.0; 95% CI: 1.7 to 26.8). The risk persisted when only subjects with migraine with or without aura were evaluated (OR = 5.0; 95% CI: 1.2 to 20.9). CONCLUSIONS: Migraine headaches in adolescents have a favorable long-term prognosis. Familial disposition for migraine predicted a poorer outcome, especially in subjects with migraine without aura.
Tension headache research :- PMID: 17060559 [PubMed - indexed for MEDLINE :- Tension headache research]Does this patient with headache have a migraine or need neuroimaging? Related Articles
Does this patient with headache have a migraine or need neuroimaging?
JAMA. 2006 Sep 13;296(10):1274-83
Tension headache research :- Authors: Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM
CONTEXT: In assessing the patient with headache, clinicians are often faced with 2 important questions: Is this headache a migraine? Does this patient require neuroimaging? The diagnosis of migraine can direct therapy, and information obtained from the history and physical examination is used by physicians to determine which patients require neuroimaging. OBJECTIVE: To determine the usefulness of the history and physical examination that distinguish patients with migraine from those with other headache types and that identify those patients who should undergo neuroimaging. DATA SOURCES AND STUDY SELECTION: A systematic review was performed using articles from MEDLINE :- Tension headache research (1966-November 2005) that assessed the performance characteristics of screening questions in diagnosing migraine (with the International Headache Society diagnostic criteria as a gold standard) and addressed the accuracy of the clinical examination in predicting the presence of underlying intracranial pathology (with computed tomography/magnetic resonance imaging as the reference standard). DATA EXTRACTION: Two Tension headache research :- Authors independently reviewed each study to determine eligibility, abstract data, and classify methodological quality using predetermined criteria. Disagreement was resolved by consensus with a third author. DATA SYNTHESIS: Four studies of screening questions for migraine (n = 1745 patients) and 11 neuroimaging studies (n = 3725 patients) met inclusion criteria. All 4 of the migraine studies illustrated high sensitivity and specificity if 3 or 4 criteria were met. The best predictors can be summarized by the mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling). If 4 of the 5 criteria are met, the likelihood ratio (LR) for definite or possible migraine is 24 (95% confidence interval [CI], 1.5-388); if 3 are met, the LR is 3.5 (95% CI, 1.3-9.2), and if 2 or fewer are met, the LR is 0.41 (95% CI, 0.32-0.52). For the neuroimaging question, several clinical features were found on pooled analysis to predict the presence of a serious intracranial abnormality: cluster-type headache (LR, 10.7; 95% CI, 2.2-52); abnormal findings on neurologic examination (LR, 5.3; 95% CI, 2.4-12); undefined headache (ie, not cluster-, migraine-, or tension-type) (LR, 3.8; 95% CI, 2.0-7.1); headache with aura (LR, 3.2; 95% CI, 1.6-6.6); headache aggravated by exertion or a valsalva-like maneuver (LR, 2.3; 95% CI, 1.4-3.8); and headache with vomiting (LR, 1.8; 95% CI, 1.2-2.6). No clinical features were useful in ruling out significant pathologic conditions. CONCLUSIONS: The presence of 4 simple historical features can accurately diagnose migraine. Several individual clinical features were found to be associated with a significant intracranial abnormality, and patients with these features should undergo neuroimaging.
Tension headache research :- PMID: 16968852 [PubMed - indexed for MEDLINE :- Tension headache research]Obesity is a risk factor for transformed migraine but not chronic tension-type headache. Related Articles
Obesity is a risk factor for transformed migraine but not chronic tension-type headache.
Neurology. 2006 Jul 25;67(2):252-7
Tension headache research :- Authors: Bigal ME, Lipton RB
OBJECTIVE: To assess the influence of the body mass index (BMI) on the prevalence and severity of chronic daily headache (CDH) and its most frequent subtypes, transformed migraine (TM) and chronic tension-type headache (CTTH). METHODS: The Tension headache research :- Authors gathered information on headache, medical features, height, and weight using a computer-assisted telephone interview. Participants were divided into five categories, based on BMI: underweight (<18.5), normal weight (18.5 to 24.9), overweight (25 to 29.9), obese (30 to 34.9), and morbidly obese (>35). The prevalence and severity of CDH, TM, and CTTH were assessed. Multivariate analyses modeling these diagnoses as a function of BMI were conducted. RESULTS: Among 30,215 participants, the prevalence of CDH was 4.1%; 1.3% had TM and 2.8% CTTH. In contrast with the normal weight group (3.9%), the prevalence of CDH was higher in obese (5.0% [odds ratio (OR) = 1.3, 95% CI = 1.1-1.6]) and morbidly obese (6.8% [OR = 1.8, 95% CI = 1.4 to 2.2]). BMI had a strong influence on the prevalence of TM, which ranged from 0.9% of the normal weighted to 1.2% of the overweight (OR = 1.4 [1.1 to 1.8]), 1.6% of the obese (OR = 1.7 [1.2 to 2.43]), and 2.5% of the morbidly obese (OR = 2.2 [1.5 to 3.2]). The effects of the BMI on the prevalence of CTTH were just significant in the morbidly obese group. Adjusted analyses showed that obesity was associated with CDH and TM but not CTTH. CONCLUSIONS: Chronic daily headache and obesity are associated. Obesity is a stronger risk factor for transformed migraine than for chronic tension-type headache.
Tension headache research :- PMID: 16864817 [PubMed - indexed for MEDLINE :- Tension headache research]Characteristics and treatment of headache after traumatic brain injury: a focused review. Related Articles
Characteristics and treatment of headache after traumatic brain injury: a focused review.
Am J Phys Med Rehabil. 2006 Jul;85(7):619-27
Tension headache research :- Authors: Lew HL, Lin PH, Fuh JL, Wang SJ, Clark DJ, Walker WC
Headache is one of the most common complaints in patients with traumatic brain injury. By definition, headache that develops within 1 wk after head trauma (or within 1 wk after regaining consciousness) is referred to as posttraumatic headache (PTH). Although most PTH resolves within 6-12 mos after injury, approximately 18-33% of PTH persists beyond 1 yr. We performed a systematic literature review on this topic and found that many patients with PTH had clinical presentations very similar to tension-type headache (37% of all PTH) and migraine (29% of all PTH). Although there is no universally accepted protocol for treating PTH, many clinicians treat PTH as if they were managing primary headache. As a result of the heterogeneity in the terminology and paucity in prospective, well-controlled studies in this field, there is a definite need for conducting double-blind, placebo-controlled treatment trials in patients with PTH.
Tension headache research :- PMID: 16788394 [PubMed - indexed for MEDLINE :- Tension headache research]Probable medication-overuse headache: the effect of a 2-month drug-free period. Related Articles
Probable medication-overuse headache: the effect of a 2-month drug-free period.
Neurology. 2006 Jun 27;66(12):1894-8
Tension headache research :- Authors: Zeeberg P, Olesen J, Jensen R
OBJECTIVE: To describe the emerging profile of headache frequency following a 2-month drug-free period in patients with medication overuse. METHODS: All patients treated and discharged from Danish Headache Center in 2002 and 2003 had prospectively filled out a diagnostic headache diary on a daily basis. For patients with probable medication-overuse headache (MOH), the Tension headache research :- Authors determined headache frequencies before and after medication withdrawal from these prospective recordings. RESULTS: Among 1,326 patients, 337 had probable MOH. Two hundred sixteen patients who stayed medication-free for 2 months were eligible. Overall, 45% of the patients improved, 48% had no change, and 7% had more headaches. Median age was 48 years, and male/female ratio 1:2.7. The relative reduction in headache frequency varied considerably with a 67% median reduction in migraine, 0% in tension-type headache (TTH), and 37% in patients with both migraine and TTH (MT). Comparing the diagnostic groups, the relative reduction in frequency differed between migraine and TTH (p < 0.001) and between MT and TTH (p < 0.01). Triptan/ergot overusers improved the most (p < 0.0001). The difference between MT and TTH remained significant when triptan/ergot overuse was controlled (p < 0.05). CONCLUSION: These data demonstrate the benefit of withdrawal in already established medication overuse and support the existence of medication-overuse headache as a clinical entity.
Tension headache research :- PMID: 16707727 [PubMed - indexed for MEDLINE :- Tension headache research]Analgesic overuse among adolescents with headache: the Head-HUNT-Youth Study. Related Articles
Analgesic overuse among adolescents with headache: the Head-HUNT-Youth Study.
Neurology. 2006 Jan 24;66(2):198-201
Tension headache research :- Authors: Dyb G, Holmen TL, Zwart JA
OBJECTIVES: To examine the association between the use of analgesics and primary headache disorders (i.e., migraine and tension-type headache) among adolescents in relation to age, gender, and headache frequency. METHODS: This cross-sectional, population-based study was conducted in Norway from 1995 to 1997. The total study population consisted of 5,471 adolescents, 13 to 18 years of age, who were interviewed about their headache complaints and completed a comprehensive questionnaire including use of analgesics. RESULTS: The prevalence of daily headache associated with analgesic use was 0.5%, with a higher rate for girls (0.8%) than for boys (0.2%). There was a significant association for both genders between analgesic use and headache, although most pronounced for migraine. There was a significant linear relationship between analgesic use and headache frequency. Analgesic use was more common among girls than boys and increased with age both for those with and those without headache. CONCLUSIONS: The use of analgesics is common among adolescents with headache, especially among girls. Although this study did not directly evaluate for medication-overuse headache, the trend of frequent analgesic use suggests this possibility. Parents and physicians should increase their awareness of potential analgesic overuse, especially among adolescents with frequent headache.
Tension headache research :- PMID: 16434653 [PubMed - indexed for MEDLINE :- Tension headache research]Chronic daily headache in adolescents: prevalence, impact, and medication overuse. Related Articles
Chronic daily headache in adolescents: prevalence, impact, and medication overuse.
Neurology. 2006 Jan 24;66(2):193-7
Tension headache research :- Authors: Wang SJ, Fuh JL, Lu SR, Juang KD
OBJECTIVES: To examine the prevalence, impact, and related medication use or overuse of primary chronic daily headache (CDH) among adolescents in a field sample. METHODS: The Tension headache research :- Authors conducted a two-phase CDH survey of all students from ages 12 to 14 years in five selected middle schools in Taiwan. Subjects with CDH in the past year were identified and interviewed by neurologists. CDH was defined as headache occurring at a frequency of 15 days/month or more, average of 2 hours/day or more, for more than 3 months, and its subtypes were classified on the basis of the International Classification of Headache Disorders, 2nd edition. RESULTS: Of the 7,900 participants, 122 (1.5%) fulfilled the criteria for primary CDH in the past year. Girls had a higher prevalence (2.4%) than boys (0.8%) (p < 0.001). Of the CDH subjects, 88 (72%) could be classified into either chronic tension-type headache (65.6%) or chronic migraine (6.6%). None of them fulfilled the criteria of new daily-persistent headache or hemicrania continua. Twenty-four subjects (20%) overused medications. Eighty-two (67%) of all CDH subjects had migraine or probable migraine. In the past semester, most CDH subjects (65%) did not take any sick leave for headaches. Only 6 subjects consulted neurologists in the past year, and only 1 subject took headache prophylactic agents. CONCLUSIONS: Chronic daily headache (CDH) was common in a large nonreferred adolescent sample. Based on the International Classification of Headache Disorders, 2nd edition, criteria, chronic tension-type headache was the most common subtype; however, a majority of adolescents with CDH had headaches with features of migraine.
Tension headache research :- PMID: 16434652 [PubMed - indexed for MEDLINE :- Tension headache research]The prognosis of childhood headache: a 20-year follow-up. Related Articles
The prognosis of childhood headache: a 20-year follow-up.
Tension headache research :- Authors: Brna P, Dooley J, Gordon K, Dewan T
BACKGROUND: Headaches affect most children and rank third among illness-related causes of school absenteeism. Although the short-term outcome for most children appears favorable, few studies have reported long-term outcome. OBJECTIVE: To evaluate the long-term prognosis of childhood headaches 20 years after initial diagnosis in a cohort of Atlantic Canadian children who had headaches diagnosed in 1983. METHODS: Ninety-five patients with headaches who consulted 1 of the Tension headache research :- Authors in 1983 were previously studied in 1993. The 77 patients contacted in 1993 were followed up in 2003. A standardized interview protocol was used. RESULTS: Sixty (78%) of 77 patients responded (60 of the 95 of the original cohort). At 20-year follow-up, 16 (27%) were headache free, 20 (33%) had tension-type headaches, 10 (17%) had migraine, and 14 (23%) had migraine and tension-type headaches. Having more than 1 headache type was more prevalent than at diagnosis or initial follow-up (P<.001), and headache type varied across time. Of those with headaches at follow-up, 80% (35/44) described their headaches as moderate or severe, although an improvement in headaches was reported by 29 (66%). Tension-type headaches were more likely than migraine to remit (P<.04). Headache severity at diagnosis was predictive of headache outcome at 20 years. During the month before follow-up, nonprescription medications were used by 31 (70%) of those with ongoing headaches, and prescription medications were used by 6 (14%). However, 20 (45%) believed that nonpharmacological methods were most effective. Medication use increased during the 10 years since last follow-up. No patient used selective serotonin receptor agonists (triptans). CONCLUSIONS: Twenty years after diagnosis of pediatric headache, most patients continue to have headache, although the headache classification often changes across time. Most patients report moderate or severe headache and increasingly choose to care for their headaches pharmacologically.
Tension headache research :- PMID: 16330740 [PubMed - indexed for MEDLINE :- Tension headache research]Gray matter decrease in patients with chronic tension type headache. Related Articles
Gray matter decrease in patients with chronic tension type headache.
Neurology. 2005 Nov 8;65(9):1483-6
Tension headache research :- Authors: Schmidt-Wilcke T, Leinisch E, Straube A, Kämpfe N, Draganski B, Diener HC, Bogdahn U, May A
Using MRI and voxel-based morphometry, the Tension headache research :- Authors investigated 20 patients with chronic tension type headache (CTTH) and 20 patients with medication-overuse headache and compared them to 40 controls with no headache history. Only patients with CTTH demonstrated a significant gray matter decrease in regions known to be involved in pain processing. The finding implies that the alterations are specific to CTTH rather than a response to chronic head pain or chronification per se.
Tension headache research :- PMID: 16275843 [PubMed - indexed for MEDLINE :- Tension headache research]Prognosis of migraine and tension-type headache: a population-based follow-up study. Related Articles
Prognosis of migraine and tension-type headache: a population-based follow-up study.
Neurology. 2005 Aug 23;65(4):580-5
Tension headache research :- Authors: Lyngberg AC, Rasmussen BK, Jørgensen T, Jensen R
OBJECTIVE: To determine the prognosis of migraine and tension-type headache and to identify prognostic factors. METHODS: Of 740 persons (aged 25 to 64 years) examined in a 1989 Danish cross-sectional headache study, 673 were eligible for follow-up in 2001. All interviews at baseline and at follow-up were conducted by medical doctors and based on the 1988 IHS-criteria. RESULTS: A total of 549 persons (81.6%) participated in the follow-up study. Of 64 migraineurs at baseline, 42% had experienced remission, 38% had low migraine frequency, and 20% had more than 14 migraine days per year (poor outcome) at follow-up. Poor outcome was associated with high migraine frequency at baseline and age at onset younger than 20 years. Among 146 subjects with frequent episodic tension-type headache and 15 with chronic tension-type headache at baseline, 45% experienced infrequent or no tension-type headache (remission), 39% had frequent episodic tension-type headache, and 16% experienced chronic tension-type headache (poor outcome) at follow-up. Poor outcome was associated with baseline chronic tension-type headache, coexisting migraine, not being married, and sleeping problems. CONCLUSIONS: The prognosis of migraine, frequent episodic tension-type headache, and chronic tension-type headache was favorable.
Tension headache research :- PMID: 16116119 [PubMed - indexed for MEDLINE :- Tension headache research]Serious neurological disorders in children with chronic headache. Related Articles
Serious neurological disorders in children with chronic headache.
Arch Dis Child. 2005 Sep;90(9):937-40
Tension headache research :- Authors: Abu-Arafeh I, Macleod S
AIMS: To determine the prevalence of serious neurological disorders among children with chronic headache. METHODS: All children presenting to a specialist headache clinic over seven years with headache as their main complaint were assessed by clinical history, physical and neurological examination, neuroimaging where indicated, and by follow up using prospective headache diaries. RESULTS: A total of 815 children and adolescents (1.25-18.75 years of age, mean 10.8 years (SD 2.9); 432 male) were assessed. Mean duration of headache was 21.2 months (SD 21.2). Neuroimaging (brain CT or MRI) was carried out on 142 (17.5%) children. The vast majority of patients had idiopathic headache (migraine, tension, or unclassified headaches). Fifty one children (6.3%) had other chronic neurological disorders that were unrelated to the headache. The headache in three children (0.37%, 95% CI 0.08% to 1.1%) was related to active intracranial pathology which was predictable on clinical findings in two children but was unexpected until a later stage in one child (0.12%, 95% CI 0.006% to 0.68%). CONCLUSIONS: Chronic headache in childhood is rarely due to serious intracranial pathology. Careful history and thorough clinical examination will identify most patients with serious underlying brain abnormalities. Change in headache symptomatology or personality change should lower the threshold for imaging.
Tension headache research :- PMID: 16113128 [PubMed - indexed for MEDLINE :- Tension headache research]Acupuncture in patients with tension-type headache: randomised controlled trial. Related Articles
Acupuncture in patients with tension-type headache: randomised controlled trial.
BMJ. 2005 Aug 13;331(7513):376-82
Tension headache research :- Authors: Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes M, Hummelsberger J, Irnich D, Weidenhammer W, Willich SN, Linde K
OBJECTIVE: To investigate the effectiveness of acupuncture compared with minimal acupuncture and with no acupuncture in patients with tension-type headache. DESIGN: Three armed randomised controlled multicentre trial. SETTING: 28 outpatient centres in Germany. PARTICIPANTS: 270 patients (74% women, mean age 43 (SD 13) years) with episodic or chronic tension-type headache. INTERVENTIONS: Acupuncture, minimal acupuncture (superficial needling at non-acupuncture points), or waiting list control. Acupuncture and minimal acupuncture were administered by specialised physicians and consisted of 12 sessions per patient over eight weeks. MAIN OUTCOME MEASURE: Difference in numbers of days with headache between the four weeks before randomisation and weeks 9-12 after randomisation, as recorded by participants in headache diaries. RESULTS: The number of days with headache decreased by 7.2 (SD 6.5) days in the acupuncture group compared with 6.6 (SD 6.0) days in the minimal acupuncture group and 1.5 (SD 3.7) days in the waiting list group (difference: acupuncture v minimal acupuncture, 0.6 days, 95% confidence interval -1.5 to 2.6 days, P = 0.58; acupuncture v waiting list, 5.7 days, 3.9 to 7.5 days, P < 0.001). The proportion of responders (at least 50% reduction in days with headache) was 46% in the acupuncture group, 35% in the minimal acupuncture group, and 4% in the waiting list group. CONCLUSIONS: The acupuncture intervention investigated in this trial was more effective than no treatment but not significantly more effective than minimal acupuncture for the treatment of tension-type headache. TRIAL REGISTRATION NUMBER: ISRCTN9737659.
Tension headache research :- PMID: 16055451 [PubMed - indexed for MEDLINE :- Tension headache research]Primary chronic daily headache and its subtypes in adolescents and adults. Related Articles
Primary chronic daily headache and its subtypes in adolescents and adults.
OBJECTIVES: To determine the relative frequency of chronic daily headache (CDH) subtypes in adolescents and to compare the distribution of CDH subtypes in adolescents and adults of various ages. METHODS: Adolescents (13 to 17 years, n = 170) and adults (18 or older, n = 638) were recruited during the same time frame. CDH subtypes were classified according the criteria proposed by Silberstein and Lipton (1996) as transformed migraine (TM), chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). RESULTS: Among adolescents and adults there were substantial differences in the distribution of CDH subtypes. The relative frequency of TM was lower in adolescents (68.8% vs 87.4%, p < 0.001), while NDPH (21.1% vs 10.8%, p < 0.001) and CTTH (10.1% vs 0.9%, p < 0.0001) were more common. HC (0 vs 0.9%, NS) was equally rare. The lower relative frequency of TM in adolescents was accounted for by TM with medication overuse (TM+), much more common in adults (28.2% vs 62.5%, p < 0.001). In fact, TM without medication overuse (TM-) was more common in adolescents (40.5% vs 24.9%, p < 0.001). The relative frequency of TM+ increased until the age of 50 years (p < 0.001). CONCLUSIONS: In adolescents with CDH, TM usually develops without medication overuse. Adolescents with the early onset form of TM may develop the disorder in the absence of medication overuse because they are at increased biologic risk.
Tension headache research :- PMID: 15365134 [PubMed - indexed for MEDLINE :- Tension headache research]Intracerebral pneumatocele presenting after air travel. Related Articles
Intracerebral pneumatocele presenting after air travel.
J Neurosurg. 2004 Aug;101(2):340-2
Tension headache research :- Authors: Mahabir RC, Szymczak A, Sutherland GR
In this report the Tension headache research :- Authors discuss a patient who experienced symptoms of an acute right frontal, intraparenchymal pneumatocele while on an airplane descending to an international airport. This rare complication of an ethmoid sinus osteoma that eroded upward through the dura mater is described along with a literature review. A persistent headache and inappropriate behavior consistent with a frontal lobe syndrome brought the patient to clinical and imaging evaluation, which revealed a large right frontal lobe pneumatocele and an associated ethmoid sinus osteoma extending upward into the frontal lobe. Through a right frontal craniotomy, the air cavity was evacuated, the osteoma partially excised, and the dural defect closed using a vascularized pericranial flap. Postoperatively, the patient made an unremarkable recovery. For patients with air sinus osteomas extending into the cranial cavity, air travel or other barotrauma may result in a life-threatening tension pneumatocele.
Tension headache research :- PMID: 15309929 [PubMed - indexed for MEDLINE :- Tension headache research]Classification of primary headaches. Related Articles
Given the range of disorders that produce headache, a systematic approach to classification and diagnosis is an essential prelude to clinical management. For the last 15 years, the diagnostic criteria of the International Headache Society (IHS) have been the accepted standard. The second edition of The International Classification of Headache Disorders (January 2004) reflects our improved understanding of some disorders and the identification of new disorders. Neurologists who treat headache should become familiar with the revised criteria. Like its predecessor, the second edition of the IHS classification separates headache into primary and secondary disorders. The four categories of primary headaches include migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalalgias, and other primary headaches. There are eight categories of secondary headache. Important changes in the second edition include a restructuring of these criteria for migraine, a new subclassification of tension-type headache, introduction of the concept of trigeminal autonomic cephalalgias, and addition of previously unclassified primary headaches. Several disorders were eliminated or reclassified. In this article, the Tension headache research :- Authors present an overview of the revised IHS classification, highlighting the primary headache disorders and their diagnostic criteria. They conclude by presenting an approach to headache diagnosis based upon these criteria.
Tension headache research :- PMID: 15304572 [PubMed - indexed for MEDLINE :- Tension headache research]The relative influence of environment and genes in episodic tension-type headache. Related Articles
The relative influence of environment and genes in episodic tension-type headache.
Neurology. 2004 Jun 8;62(11):2065-9
Tension headache research :- Authors: Ulrich V, Gervil M, Olesen J
OBJECTIVE: To examine the relative importance of genetic and environmental influence for the development of tension-type headache by analyses of twins. METHODS: The Tension headache research :- Authors screened by questionnaire a population of 5,360 twins born during 1953 to 1960 from the general population for migraine and headache symptoms. The response rate of the questionnaire was 87%. All twin pairs with at least one twin of the pair reporting migraine or headache symptoms were interviewed by telephone by a physician. Correlation of liability and structural equation modeling were applied on tension-type headache. RESULTS: A total of 1,417 subjects had tension-type headache equivalent to a 1-year prevalence of 62%. The male: female ratio was 1:1.24. Chronic tension-type headache was found in 49 twins corresponding to a prevalence of 2% with a male:female ratio of 1:1.21. The prevalence, pain characteristics, frequency, and duration of tension-type headache were similar to what has been found in the general Danish population. The correlation of liability of tension-type headache was low and not significantly different in monozygotic and dizygotic twin pairs: 0.21 (0.03 to 0.39), 0.08 (0 to 0.24). The best fitting model of phenotypic variation consisted of 81% non-shared environmental effects and of 19% additive genetic effects. CONCLUSIONS: Environmental influence is of major importance for episodic tension-type headache and a genetic factor, if it exits, is minor. In chronic tension-type headache the genetic factor may be more important. These data clearly separate episodic tension-type headache from migraine without aura where the phenotypic variation consists of non-shared environmental effects of 39% and of 61% additive genetic effects.
Tension headache research :- PMID: 15184615 [PubMed - indexed for MEDLINE :- Tension headache research]Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Related Articles
Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache.
Neurology. 2004 May 25;62(10):1706-11
Tension headache research :- Authors: Bendtsen L, Jensen R
BACKGROUND: The tricyclic antidepressant amitriptyline is the only drug with prophylactic efficacy for chronic tension-type headache. However, amitriptyline is only moderately effective, with headache reduction of approximately 30%, and treatment is often hampered by side effects. Mirtazapine is a relatively new so-called noradrenergic and specific serotonergic antidepressant, which is more specific and therefore generally better tolerated. OBJECTIVE: To evaluate the efficacy of mirtazapine. METHODS: Twenty-four nondepressed patients with chronic tension-type headache were included in a randomized, double-blind, placebo-controlled, crossover trial. All patients had tried numerous other treatments. Mirtazapine 15 to 30 mg/day or placebo was each given for 8 weeks separated by a 2-week wash-out period. RESULTS: Twenty-two patients completed the study. The primary efficacy variable, area-under-the-headache curve (AUC; duration x intensity), was lower during treatment with mirtazapine (843) than during treatment with placebo (1,275) (p = 0.01). Mirtazapine also reduced the secondary efficacy variables headache frequency (p = 0.005), headache duration (p = 0.03), and headache intensity (p = 0.03) and was well tolerated. CONCLUSIONS: Mirtazapine reduced AUC by 34% more than placebo in difficult-to-treat patients. This finding is clinically relevant and may stimulate the development of prophylactic treatments with increased efficacy and fewer side effects for tension-type headache and other types of chronic pain.
Tension headache research :- PMID: 15159466 [PubMed - indexed for MEDLINE :- Tension headache research]Chronic daily headache with analgesic overuse: epidemiology and impact on quality of life. Related Articles
Chronic daily headache with analgesic overuse: epidemiology and impact on quality of life.
OBJECTIVE: To analyze the prevalence and demography of chronic daily headache (CDH) with analgesic overuse. METHODS: A population of 9,984 inhabitants aged 14 or older living in Santoña, Spain, was studied. The Tension headache research :- Authors personally interviewed 4,855 subjects, using a quota sampling approach. Those with headache for > or = 10 days/month and some analgesic use were asked to fill in a diary over the course of 1 month. Then, subjects were classified into CDH with or without analgesic overuse subtypes. Quality of life (Short Form-36 Health Survey [SF-36]) was also assessed in this second interview. RESULTS: Headache for > or = 10 days/month with analgesic consumption was reported by 332 subjects. Seven had secondary headache. Seventy-four (standardized prevalence 1.41%, 95% CI 1.1 to 1.8) fulfilled criteria for CDH with analgesic overuse. Prevalence in women (2.6%, 2.0 to 3.3) was much higher than in men (0.19%, 0.006 to 0.52). Mean age was 56 years (range 19 to 82 years). As recalled by the subjects, the mean age at onset of CDH was 38 years (range 9 to 82 years), whereas the mean age at onset of CDH with frequent analgesic consumption was 45 years (range 19 to 80 years) and that of primary headache was 22 years (range 5 to 60 years). CDH subjects showed a significant decrease in each SF-36 health-related score as compared with healthy control subjects. Transformed migraine was diagnosed in 49 (prevalence 0.9%), chronic tension-type headache in 20 (0.4%), and new daily persistent headache in 5 (0.1%). Thirty-five percent of patients overused simple analgesics, 22% ergotics, 12.5% opioids, and 2.7% triptans; the remaining 27.8% were overusing different combinations. CONCLUSION: CDH with analgesic overuse is a common disorder in the general population, mainly in women in their fifties, in whom 5% meet its diagnostic criteria.
Tension headache research :- PMID: 15111671 [PubMed - indexed for MEDLINE :- Tension headache research]A meta-analysis for headache in systemic lupus erythematosus: the evidence and the myth. Related Articles
A meta-analysis for headache in systemic lupus erythematosus: the evidence and the myth.
Controversies in the occurrence and implications of headache in patients suffering from systemic lupus erythematosus (SLE) triggered us to conduct an extensive literature search in order to answer five clinical questions. (i) Is headache prevalence higher in SLE patients than in the general population? (ii) Is 'lupus headache' a separate entity? (iii) Is there a distinct pathogenetic mechanism of headache in SLE? (iv) Is headache related to CNS involvement or general SLE activity? (v) Is headache related to anxiety- and depression-like symptoms in SLE? All published articles reporting data from >30 SLE patients were classified into four classes (I, IIa, IIb and III) by the quality of their evidence. We found no prospective controlled study (class I), but we identified seven controlled (class II) and 28 uncontrolled studies (class III) that retrospectively investigated the occurrence of headache in SLE patients. Eight out of 35 studies applied the International Headache Society (IHS) criteria for headache classification, whereas only four uncontrolled studies investigated paediatric SLE populations (class III). Pooled data from eight studies (controlled and uncontrolled) that used the IHS criteria show that 57.1% of SLE patients reported any type of headache (migraine 31.7% and tension-type headache 23.5%). Pooled data from seven controlled studies showed that the prevalence of all headache types, including migraine, was not different from controls. Insufficient evidence was found for the concept of 'lupus headache'. No particular pathogenetic mechanism of headache in adult SLE patients has been identified, nor an association between headache and the disease status, including CNS involvement. There is no good evidence that headache is associated with anxiety and depression in SLE. Insufficient data (class III) do not allow safe conclusions for headache among paediatric SLE patients. These findings suggest that the occurrence of headache in adult SLE patients does not itself require further investigation and that headache in those patients should be classified according to IHS criteria and managed as primary headache if there is no specific indication of a role for SLE in the patient. These recommendations should be verified by a properly controlled and prospective study in both adult and paediatric populations.
Tension headache research :- PMID: 15047589 [PubMed - indexed for MEDLINE :- Tension headache research]Migraine throughout the life cycle: treatment through the ages. Related Articles
Migraine throughout the life cycle: treatment through the ages.
Neurology. 2004 Mar 9;62(5 Suppl 2):S2-8
Tension headache research :- Authors: Landy S
Migraine seriously impairs the quality of life in those who suffer from it and exacts a high socioeconomic cost in lost productivity. About half of all persons with migraine go undiagnosed. To avoid misdiagnosis of migraine, clinicians must be prepared to recognize atypical presentations, including tension headache-like and "sinus" symptoms. Nonpharmacologic treatments, including relaxation training and thermal or EMG biofeedback training, may be appropriate for some patients. Pharmacotherapy for migraine may be acute or preventive. In prescribing treatment, the clinician should consider the characteristics of the patient's headaches, the patient's medication history and preferences, and co-morbidities. For acute treatment in patients with more severe migraine and those whose headaches respond poorly to nonsteroidal anti-inflammatory drugs or combination analgesics, migraine-specific agents, such as triptans, dihydroergotamine, and ergotamine, are recommended. Early intervention--identifying and treating the headache during the mild phase--is often a key to successful management. Preventive treatment of migraine may be appropriate to reduce the frequency, severity, and duration of migraine attacks, to improve the response to acute treatment, and to reduce disability. Clinicians who treat migraine must be aware of considerations specific to children, women, and the elderly.
Tension headache research :- PMID: 15007158 [PubMed - indexed for MEDLINE :- Tension headache research]Initial misdiagnosis and outcome after subarachnoid hemorrhage. Related Articles
Initial misdiagnosis and outcome after subarachnoid hemorrhage.
JAMA. 2004 Feb 18;291(7):866-9
Tension headache research :- Authors: Kowalski RG, Claassen J, Kreiter KT, Bates JE, Ostapkovich ND, Connolly ES, Mayer SA
CONTEXT: Mortality and morbidity can be reduced if aneurysmal subarachnoid hemorrhage (SAH) is treated urgently. OBJECTIVE: To determine the association of initial misdiagnosis and outcome after SAH. DESIGN, SETTING, AND PARTICIPANTS: Inception cohort of 482 SAH patients admitted to a tertiary care urban hospital between August 1996 and August 2001. MAIN OUTCOME MEASURES: Misdiagnosis was defined as failure to correctly diagnose SAH at a patient's initial contact with a medical professional. Functional outcome was assessed at 3 and 12 months with the modified Rankin Scale; quality of life (QOL), with the Sickness Impact Profile. RESULTS: Fifty-six patients (12%) were initially misdiagnosed, including 42 of 221 (19%) of those with normal mental status at first contact. Migraine or tension headache (36%) was the most common incorrect diagnosis, and failure to obtain a computed tomography (CT) scan was the most common diagnostic error (73%). Neurologic complications occurred in 22 patients (39%) before they were correctly diagnosed, including 12 patients (21%) who experienced rebleeding. Normal mental status, small SAH volume, and right-sided aneurysm location were independently associated with misdiagnosis. Among patients with normal mental status at first contact, misdiagnosis was associated with worse QOL at 3 months and an increased risk of death or severe disability at 12 months. CONCLUSIONS: In this study, misdiagnosis of SAH occurred in 12% of patients and was associated with a smaller hemorrhage and normal mental status. Among individuals who initially present in good condition, misdiagnosis is associated with increased mortality and morbidity. A low threshold for CT scanning of patients with mild symptoms that are suggestive of SAH may reduce the frequency of misdiagnosis.
Tension headache research :- PMID: 14970066 [PubMed - indexed for MEDLINE :- Tension headache research]Headache associated with sexual activity: demography, clinical features, and comorbidity. Related Articles
Headache associated with sexual activity: demography, clinical features, and comorbidity.
Neurology. 2003 Sep 23;61(6):796-800
Tension headache research :- Authors: Frese A, Eikermann A, Frese K, Schwaag S, Husstedt IW, Evers S
OBJECTIVE:S: To provide data on the demography, clinical features, and comorbidity of headache associated with sexual activity (HSA). METHODS: Between 1996 and 2001, 51 patients with the diagnosis of HSA were questioned using a structured interview. RESULTS: The mean age at onset was 39.2 (+/-11.1) years. There was a clear male preponderance (2.9:1). The age at onset had two peaks, with a first peak between the 20th and 24th (n = 13) years of life and a second peak between the 35th and 44th (n = 20) years of life. Eleven patients had HSA type 1 (dull subtype), which gradually increased with increasing sexual excitement. The remaining (n = 40) had HSA type 2 (explosive subtype). The pain was predominantly bilateral (67%), and diffuse or occipital (76%). The quality was nearly equally distributed among dull, throbbing, and stabbing. HSA was not dependent on specific sexual habits and most often occurred during sexual activity with the usual partner (94%) and during masturbation (35%). There was a high comorbidity with migraine (25%), benign exertional headache (29%), and tension-type headache (45%). HSA types 1 and 2 did not significantly differ in demography, clinical features, or comorbidity, except for a higher probability of stopping the attack by breaking off sexual activity in HSA type 1. There were no cases with HSA type 3 (postural subtype). CONCLUSION: Mean age at onset, a male preponderance, a predominantly bilateral and occipital pain, and a high comorbidity with other primary headaches are in concordance with case reports in the literature. The Tension headache research :- Authors found two peaks for the age at onset, however. There was no clinical evidence proving subtypes 1 and 2 to be distinct disorders. HSA types 1 and 2 may be different manifestations of the same disease rather than distinct entities.
Tension headache research :- PMID: 14504323 [PubMed - indexed for MEDLINE :- Tension headache research]Rates and predictors for relapse in medication overuse headache: a 1-year prospective study. Related Articles
Rates and predictors for relapse in medication overuse headache: a 1-year prospective study.
Neurology. 2003 May 27;60(10):1682-3
Tension headache research :- Authors: Katsarava Z, Limmroth V, Finke M, Diener HC, Fritsche G
The Tension headache research :- Authors prospectively studied 98 patients with medication overuse headache. The 1-year relapse rate was 38% but was lower for patients with migraine compared with tension-type headache (22% vs 73%, p < or = 0.002) and combination of migraine and tension-type headache (22% vs 77%, p < or = 0.0001). The rate was also lower for patients overusing triptans than ergots (19% vs 20%, NS) and analgesics (19% vs 58%, p < or = 0.001). The long-term success of withdrawal depends on the type of primary headache and the type of overused medication.
Tension headache research :- PMID: 12771266 [PubMed - indexed for MEDLINE :- Tension headache research]Brief neurologist-administered behavioral treatment of pediatric episodic tension-type headache. Related Articles
Brief neurologist-administered behavioral treatment of pediatric episodic tension-type headache.
Neurology. 2003 Apr 8;60(7):1215-6
Tension headache research :- Authors: Andrasik F, Grazzi L, Usai S, D'Amico D, Leone M, Bussone G
Tension headache research :- PMID: 12682344 [PubMed - indexed for MEDLINE :- Tension headache research]The many causes of headache. Migraine, vascular, drug-induced, and more. Related Articles
The many causes of headache. Migraine, vascular, drug-induced, and more.
Accurate diagnosis of headache can be challenging when the pain pattern and the source are not immediately recognized. The most common types of headache are primary (i.e., migraine, tension-type, and cluster). In addition, many secondary causes of head pain have been identified. Dr Levin reviews the major types of headache as categorized by the International Headache Society and provides a list of red flags that may signal a secondary headache.
Tension headache research :- PMID: 12510448 [PubMed - indexed for MEDLINE :- Tension headache research]Modafinil reduces excessive somnolence and enhances mood in patients with myotonic dystrophy. Related Articles
Modafinil reduces excessive somnolence and enhances mood in patients with myotonic dystrophy.
Neurology. 2002 Dec 24;59(12):1876-80
Tension headache research :- Authors: MacDonald JR, Hill JD, Tarnopolsky MA
OBJECTIVE: To evaluate the potential of modafinil in reducing excessive daytime somnolence (EDS) and enhancing indexes of quality of life and mood in patients with myotonic dystrophy (DM). METHODS: Forty patients with DM were randomized to receive modafinil and placebo for 14 days each, using a double-blind, cross-over design. Before and after each trial, subjects completed handgrip strength testing, spirometry, and quality-of-life measures (RAND). On days 7 and 14, each subject completed the Epworth Sleepiness Scale (ESS), the Stanford Sleepiness Scale (SSS), and the Profile of Mood States (POMS). RESULTS: ESS scores were lower while taking modafinil (mean 248 mm; 95% confidence limit 220 to 276 mm) as compared with placebo (309 mm; 281 to 336 mm) (p < 0.001). Mean SSS scores were also lower during the modafinil trial (3.05; 2.77 to 3.33) than during the placebo trial (3.45; 3.18 to 3.71) (p < 0.05). The POMS indicated that modafinil decreased fatigue-inertia (p < 0.001) and increased vigor-activity and tension-anxiety (p < 0.001) indexes. The total mood disturbance score was also decreased during the modafinil trial as compared with placebo (p < 0.05). The RAND quality-of-life measures of energy (p < 0.001) and health change (p < 0.05) were both significantly enhanced during the modafinil treatment phase. No changes in maximal grip strength or forced expired volume in 1 second were detected over the course of the study. Headache was the most frequently reported adverse event. Four patients withdrew from the study, three because of side effects (two during modafinil ingestion and one during placebo ingestion). CONCLUSION: Modafinil reduces somnolence and improves mood in patients with DM.
Tension headache research :- PMID: 12499477 [PubMed - indexed for MEDLINE :- Tension headache research]Features of medication overuse headache following overuse of different acute headache drugs. Related Articles
Features of medication overuse headache following overuse of different acute headache drugs.
Neurology. 2002 Oct 8;59(7):1011-4
Tension headache research :- Authors: Limmroth V, Katsarava Z, Fritsche G, Przywara S, Diener HC
OBJECTIVE: To investigate pharmacologic features such as mean critical duration until onset of medication-overuse headache (MOH) (MCDO), mean critical monthly intake frequencies (MCMIF), and mean critical monthly dosages (MCMD) as well as specific clinical features of MOH after overuse of different acute headache drugs, with a focus on newly approved triptans. METHODS: In a prospective study 98 patients with MOH according to International Headache Society (IHS) criteria underwent standardized inpatient withdrawal from their medication. Patient diaries and structured interviews were used to calculate the MCDO, MCMIF, and MCMD for each substance group. RESULTS: The MCDO was shortest for triptans (1.7 years), longer for ergots (2.7 years), and longest for analgesics (4.8 years). The MCMIF was lowest for triptans (18 single doses per month), higher for ergots (37), and highest for analgesics (114). Although patients overusing ergots and analgesics typically had a daily tension-type headache, patients with triptan-induced MOH were more likely to describe a (daily) migraine-like headache or an increase in migraine frequency. CONCLUSION: Overuse of triptans leads to MOH faster and with lower dosages compared with ergots and analgesics. Clinical features of MOH depend on the type of overused headache medication. Pharmacologic and clinical characteristics of triptan-induced MOH call for the renewal of the current IHS classification.
Tension headache research :- PMID: 12370454 [PubMed - indexed for MEDLINE :- Tension headache research]Massage therapy and frequency of chronic tension headaches. Related Articles
Massage therapy and frequency of chronic tension headaches.
Am J Public Health. 2002 Oct;92(10):1657-61
Tension headache research :- Authors: Quinn C, Chandler C, Moraska A
OBJECTIVES: The effect of massage therapy on chronic nonmigraine headache was investigated. METHODS: Chronic tension headache sufferers received structured massage therapy treatment directed toward neck and shoulder muscles. Headache frequency, duration, and intensity were recorded and compared with baseline measures. RESULTS: Compared with baseline values, headache frequency was significantly reduced within the first week of the massage protocol. The reduction of headache frequency continued for the remainder of the study (P =.009). The duration of headaches tended to decrease during the massage treatment period (P =.058). Headache intensity was unaffected by massage (P =.19). CONCLUSIONS: The muscle-specific massage therapy technique used in this study has the potential to be a functional, nonpharmacological intervention for reducing the incidence of chronic tension headache.
Tension headache research :- PMID: 12356617 [PubMed - indexed for MEDLINE :- Tension headache research]Tension-type headache. Related Articles
Am Fam Physician. 2002 Sep 1;66(5):797-804
Tension headache research :- Authors: Millea PJ, Brodie JJ
Tension-type headache typically causes pain that radiates in a band-like fashion bilaterally from the forehead to the occiput. Pain often radiates to the neck muscles and is described as tightness, pressure, or dull ache. Migraine-type features (unilateral, throbbing pain, nausea, photophobia) are not present All patients with frequent or severe headaches need careful evaluation to exclude any occult serious condition that may be causing the headache. Neuroimaging is not needed in patients who have no worrisome findings on examination. Treatment of tension-type headache typically involves the use of over-the-counter analgesics. Use of pain relievers more than twice weekly places patients at risk for progression to chronic daily headache. Sedating antihistamines or antiemetics can potentiate the pain-relieving effects of standard analgesics. Analgesics combined with butalbital or opiates are often useful for tension-type pain but have an increased risk of causing chronic daily headache. Amitriptyline is the most widely researched prophylactic agent for frequent headaches. No large trials with rigorous methodologies have been conducted for most non-medication therapies. Among the commonly employed modalities are biofeedback, relaxation training, self-hypnosis, and cognitive therapy.
Tension headache research :- PMID: 12322770 [PubMed - indexed for MEDLINE :- Tension headache research]Tension-type headache a challenge for family physicians.
Tension-type headache a challenge for family physicians.
Am Fam Physician. 2002 Sep 1;66(5):728, 730, 733
Tension headache research :- Authors: Walling AD
Tension headache research :- PMID: 12322765 [PubMed - indexed for MEDLINE :- Tension headache research]Migraine and cognitive function: a life-course study. Related Articles
Migraine and cognitive function: a life-course study.
Neurology. 2002 Sep 24;59(6):904-8
Tension headache research :- Authors: Waldie KE, Hausmann M, Milne BJ, Poulton R
OBJECTIVE: To investigate the association between migraine and cognitive ability among members of a longitudinal birth cohort study. METHODS: Headache status was determined at age 26 (migraine, tension-type headache [TTH], headache-free control subjects) according to International Headache Society criteria, and data relating to cognitive and academic performance from ages 3 to 26 years were analyzed. RESULTS: Study members diagnosed with migraine were subtly but significantly impaired, compared with those with TTH and headache-free control subjects, on tests of verbal ability (especially language reception) from ages 3 to 13, independent of headache history. Performance on other tasks, including reading, arithmetic, motor, and spatial ability, was normal. The association between migraine and verbal functioning also appeared to impact on later academic success. CONCLUSION: Findings suggest that the poorer verbal performance was unlikely to have resulted from cumulative attacks and may be due to developmental factors beginning in utero.
Tension headache research :- PMID: 12297575 [PubMed - indexed for MEDLINE :- Tension headache research]Chronic headache: New advances in treatment strategies. Related Articles
Chronic headache: New advances in treatment strategies.
Neurology. 2002 Sep 10;59(5 Suppl 2):S8-13
Tension headache research :- Authors: Lake AE, Saper JR
Chronic daily headache (CDH) affects approximately 4 to 5% of the population and encompasses a number of different diagnoses, including transformed migraine, chronic tension-type headache (TTH), new-onset daily persistent headache, and hemicrania continua. Although the pathophysiology of CDH is still poorly understood, some research has suggested that each of the various subtypes of CDH may have a different pathogenesis. The goals of prophylactic therapy are to reduce the frequency, severity, and duration of headache attacks; to improve responsiveness to treatment of acute attacks; to improve function; and to reduce disability. However, opinions differ as to exactly which are the best and most appropriate outcome measures for prophylaxis. Several pharmacologic treatment options exist, including antidepressants, anticonvulsants, muscle relaxants, serotonin agonists, ergots, serotonin antagonists, antianxiety agents, and other miscellaneous drugs. Tizanidine, an alpha(2)-adrenergic agonist, has recently emerged as a promising prophylactic adjunct for CDH, which implicates a central alpha(2)-adrenergic mechanism as an important factor in the pathophysiology of CDH.
Tension headache research :- PMID: 12221150 [PubMed - indexed for MEDLINE :- Tension headache research]Headache diagnoses in patients with treated idiopathic intracranial hypertension. Related Articles
Headache diagnoses in patients with treated idiopathic intracranial hypertension.
Neurology. 2002 May 28;58(10):1551-3
Tension headache research :- Authors: Friedman DI, Rausch EA
The Tension headache research :- Authors reviewed medical records of 82 patients with idiopathic intracranial hypertension (IIH) to determine the frequency of headaches occurring after initial diagnosis and treatment of IIH, classifiable by the International Headache Society guidelines. Sixty-eight percent of patients had definable headache disorders, including episodic tension type headache (30%) and migraine without aura (20%). Patients with IIH frequently have other types of headaches, not necessarily related to increased intracranial pressure.
Tension headache research :- PMID: 12034799 [PubMed - indexed for MEDLINE :- Tension headache research]Diagnostic lessons from the spectrum study. Related Articles
Diagnostic lessons from the spectrum study.
Neurology. 2002 May 14;58(9 Suppl 6):S27-31
Tension headache research :- Authors: Lipton RB, Cady RK, Stewart WF, Wilks K, Hall C
Article abstract Migraine is a heterogeneous condition that causes symptoms that vary both among individuals and within individuals from attack to attack. We examined and reviewed several important lessons on the diagnosis of migraine learned from the distribution of headache types and patterns of treatment response in the Spectrum Study, including recruitment and diagnostic issues. The accuracy of an initial diagnosis, assigned by a clinician in the context of a clinical trial, was compared with the results of a final diagnosis, assigned by a neurologist, reviewing the initial evaluation as well as headache diaries for up to 10 attacks. Several lessons can be learned from the Spectrum Study. Recruitment difficulties teach us that disabling tension-type headache is difficult to find, suggesting that it is rare. Examination of the final diagnosis given after diary evaluations suggests that a diagnosis of migraine can usually be confirmed for patients with disabling headache. After reclassification of the final sample of 432 subjects, 24/75 (32%) patients initially clinically classified as having disabling episodic tension-type headache proved to have migraine or migrainous headache after a diary review. Among study participants, 90% of subjects with disabling headache (HIMQ score >250) had a migraine-related disorder. Treatment response suggests that, in migraineurs, tension-type headaches may have a pathophysiology similar to that of migraine. The diary data show that mild headaches in patients with disabling migraine often evolve into full-blown migraine. The Spectrum Study supports the view that, for patients with disabling episodic headache, migraine is often the correct diagnosis. In clinical practice, the suspicion of migraine should be high for patients experiencing episodic disabling headache. Assessment of headache-related disability may assist practitioners in making a diagnosis of migraine.
Tension headache research :- PMID: 12011271 [PubMed - indexed for MEDLINE :- Tension headache research]Migraine and tension-type headache: an assessment of challenges in diagnosis. Related Articles
Migraine and tension-type headache: an assessment of challenges in diagnosis.
Neurology. 2002 May 14;58(9 Suppl 6):S15-20
Tension headache research :- Authors: Kaniecki RG
The difficulty in distinguishing episodic tension-type headache from migraine headache is widely acknowledged. The misdiagnosis of migraine as tension-type headache has potentially significant consequences because it may preclude patients with disabling headaches from receiving appropriate treatment. This article explores the symptomatologic, epidemiologic, and pathophysiologic relationships among migraine and tension-type headaches with the aim of elucidating ways to improve their diagnosis and treatment. Clinical, epidemiologic, and pharmacologic data converge to suggest that rigid adherence to the IHS criteria in diagnosing migraine and tension-type headache may result in misdiagnosis of some headaches. Many migraine attacks are accompanied by tension headache-like symptoms, such as neck pain. Conversely, IHS-defined tension-type headaches are often accompanied by migraine-like symptoms, such as photophobia or phonophobia and aggravation by activity. The health-care provider caring for patients with headache should be cognizant of these overlaps and their implications for the management of patients with headache.
Tension headache research :- PMID: 12011269 [PubMed - indexed for MEDLINE :- Tension headache research]The role of concomitant headache types and non-headache co-morbidities in the underdiagnosis of migraine. Related Articles
The role of concomitant headache types and non-headache co-morbidities in the underdiagnosis of migraine.
Neurology. 2002 May 14;58(9 Suppl 6):S3-9
Tension headache research :- Authors: Diamond ML
That migraine is significantly underdiagnosed in the United States and other countries is well established. New data from a follow-up survey to the American Migraine Study II reveal that the presence of concomitant headache types and co-morbid conditions significantly affects the ability to detect and diagnose migraine. This article describes these data and explores the contribution of concomitant headache types and co-morbidities to the problem of underdiagnosis of migraine. Migraine continues to be underdiagnosed because of failure to recognize it (missed diagnosis) and because of misdiagnosis of migraine as another headache type. First, a diagnosis of migraine may be missed in the presence of other headache types that occur proportionally more frequently than migraine and thereby overshadow migraine. Second, migraine may be misdiagnosed when health-care providers inappropriately interpret specific symptoms and co-morbid conditions as indicators of the presence of a non-migraine headache type such as sinus or tension. By becoming aware of these diagnostic pitfalls and being more judicious and deliberate in diagnosing migraine and other headache types, health-care providers can improve the diagnosis of migraine and help patients to receive appropriate therapy.
Tension headache research :- PMID: 12011267 [PubMed - indexed for MEDLINE :- Tension headache research]Tension-type, the forgotten headache. How to recognize this common but undertreated condition. Related Articles
Tension-type, the forgotten headache. How to recognize this common but undertreated condition.
Tension-type headache is the most prevalent headache type, affecting most women and men at some time in their lives, and can impair job productivity and interfere with family and social time. However, despite its impact, tension-type headache is also the most misunderstood headache type. Because of these misperceptions, many affected people are reluctant to seek medical treatment. In this article, Dr Mueller discusses possible triggers of tension-type headache, appropriate evaluation, and management with pharmacologic, nonpharmacologic, and alternative therapies.
Tension headache research :- PMID: 11985132 [PubMed - indexed for MEDLINE :- Tension headache research]Quality of life in chronic daily headache: a study in a general population. Related Articles
Quality of life in chronic daily headache: a study in a general population.
OBJECTIVE: To analyze the quality of life (QoL) of subjects with chronic daily headache (CDH) in the general population. METHODS: QoL was studied, using the generic instrument Short Form-36 (SF-36), in 89 unselected subjects from an epidemiologic study in the general population who fulfilled CDH criteria. SF-36 scores were adjusted for comorbid conditions. A total of 89 healthy matched subjects were recruited as a control group. An additional matched group of 89 otherwise healthy subjects with episodic migraine was recruited as controls only to those with transformed migraine (TM). RESULTS: CDH subjects showed a significant decrease in each health-related concept of the SF-36 as compared with healthy subjects. The highest decreases were seen for role physical, bodily pain, vitality, and social functioning. There was no significant difference in SF-36 scores in subjects with chronic tension-type headache as compared with TM subjects. TM individuals showed lower values in each health-related concept when compared with patients with episodic migraine, these decreases being significant for general health, vitality, and mental health. Finally, CDH subjects without analgesic overuse showed higher values in each concept of the SF-36 than those with analgesic overuse. Despite the low proportion of abusers in this study, differences were significant for physical functioning and bodily pain. CONCLUSIONS: In the general population, CDH reduced all QoL aspects studied with the SF-36. This reduction in QoL was most marked in subjects with analgesic overuse. QoL was affected more by the chronicity than by the intensity of pain.
Tension headache research :- PMID: 11940693 [PubMed - indexed for MEDLINE :- Tension headache research]Prediction of intracranial metastases in cancer patients with headache. Related Articles
Prediction of intracranial metastases in cancer patients with headache.
Cancer. 2002 Apr 1;94(7):2063-8
Tension headache research :- Authors: Christiaans MH, Kelder JC, Arnoldus EP, Tijssen CC
BACKGROUND: The current study was conducted to investigate the diagnostic value of neurologic evaluation for the prediction of intracranial metastases in cancer patients with new or changed headache. METHODS: Between February 1997 and February 2000, general practitioners and specialists referred cancer patients with new or changed headache to the Department of Neurology at the study institution. All patients underwent a structured history and neurologic examination. Magnetic resonance imaging (MRI) of the brain was used as the gold standard for determining the presence of intracranial metastases. The association between baseline patient characteristics, history variables, and variables from the neurologic examination in patients with intracranial metastases was evaluated by univariate and multivariate logistic regression analyses in combination with receiver operating characteristic (ROC) curve analyses. RESULTS: Sixty-eight consecutive patients were included in the current study (48 females and 20 males). The mean age of the patients was 57 years (range, 24-88 years; standard deviation +/- 13.3 years). Breast carcinoma was the primary tumor in 32 patients (47.1%) and lung carcinoma was the primary tumor in 12 patients (17.6%). Intracranial metastases occurred in 22 patients (32.4%). The occurrence of intracranial metastases was predicted in the multivariate logistic regression analyses by one baseline patient characteristic variable and 2 history variables (i.e., headache duration of < or =10 weeks [odds ratio (OR) of 11.0; 95% confidence interval (95% CI), 1.1-108.2], emesis [OR of 4.0; 95% CI, 1.1-14.3], and pain not of tension- type [OR of 6.7; 95% CI, 1.8-25.1]). No variable from the neurologic examination was found to add information to the prediction model. When at least one of the three predictors was present, all patients with intracranial metastases could be identified with this prediction model. MRI could be omitted in 12 patients (26%) without intracranial metastases. The ROC area under curve of this model was 0.83. CONCLUSIONS: Intracranial metastases were found in 32.4% of the cancer patients with headache as the presenting symptom. Although 3 significant clinical predictors were found (headache duration < or =10 weeks, emesis, and pain not of tension- type), few patients could be excluded from undergoing MRI because of a low specificity. Therefore, MRI of the brain was considered to be warranted in all patients in the current study.
Tension headache research :- PMID: 11932910 [PubMed - indexed for MEDLINE :- Tension headache research]Trigger points: diagnosis and management. Related Articles
Trigger points: diagnosis and management.
Am Fam Physician. 2002 Feb 15;65(4):653-60
Tension headache research :- Authors: Alvarez DJ, Rockwell PG
Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.
Tension headache research :- PMID: 11871683 [PubMed - indexed for MEDLINE :- Tension headache research]
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