Tension HeadacheTension headache (TTH)is a primary headache. It is commoner than migraine. The pain is usually described as pressure on both sides of the head. The international headache society (IHS) have published criteria by which a diagnosis of TTH can be made:-
Tension-Type HeadacheDiagnostic criteria: A. Multiple episodes fulfilling criteria B–D B. Headache lasting from 30 minutes to 7 days C.Headache has at least two of the following characteristics: 1. bilateral location 2. pressing/tightening (non-pulsating) quality 3. mild or moderate intensity 4. not aggravated by routine physical activity such as walking or climbing stairs D. Both of the following: 1. no nausea or vomiting (anorexia may occur) 2. no more than one of photophobia or phonophobia E. Not attributed to another disorder
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Access to latest free fulltext articles on tension-type headache therapyHeadache (chronic tension-type).
Headache (chronic tension-type). Am Fam Physician. 2007 Jul 1;76(1):114-6 Authors: Silver N PMID: ( Tension Headache ) 17668850 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Multi-center randomized control trial of etizolam plus NSAID combination for tension-type headache. Intern Med. 2007;46(8):467-72 Authors: Hirata K, Tatsumoto M, Araki N, Takeshima T, Igarashi H, Shibata K, Sakai F OBJECTIVE: Benzodiazepines are commonly used for the treatment of tension-type headache (TTH), however, there are few randomized controlled trials recommending the use of these drugs in Japan. This study was undertaken to evaluate the efficacy of etizolam, a thienodiazepine derivative, in combination with a non-steroidal anti-inflammatory drug (NSAID) as an acute treatment for TTH. METHODS: The study design was a multi-center randomized control trial and included 144 patients. The diagnosis of TTH was based on the criteria of the International Classification of Headache Disorders-1 and all patients were diagnosed with episodic tension-type headache (ETTH). Changes in the severity of headache and shoulder pain were graded using a Visual Analogue Scale (VAS) before and after administration of drugs. Patients were randomized into NSAID alone (NSAID, mefenamic acid, 250 mg) group and NSAID (mefenamic acid, 250 mg) plus etizolam (0.5 mg) (NSAID-ET) group prior to treatment. RESULTS: Although both groups showed a significant drop in VAS for headache and shoulder pain (p<0.01), there was no overall significant difference between the NSAID-ET and NSAID groups. However, headache was improved significantly in female patients (p<0.05), and shoulder pain was improved in young and female patients (p<0.05, p<0.04) in the NSAID-ET group. CONCLUSION: This study indicates that the combination treatment of etizolam and NSAID is useful in young or female patients. PMID: ( Tension Headache ) 17443036 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Peppermint oil. Am Fam Physician. 2007 Apr 1;75(7):1027-30 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. PMID: ( Tension Headache ) 17427617 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Blindness and bias in a trial of antidepressant medication for chronic tension-type headache. Cephalalgia. 2006 Aug;26(8):973-82 Authors: Holroyd KA, Tkachuk G, O'Donnell F, Cordingley GE This study aimed to examine penetration of the blind in a randomized, placebo-controlled trial. Neurologists' ratings of improvement and medication side-effects, participants' ratings of improvement and daily diary recordings of headaches were assessed along with participants' and neurologists' guesses about treatment group placement in participants who completed at least 3 months of treatment (N = 169). Despite blinding, treating neurologists successfully identified the medication condition for 82% of participants receiving medication only; trial participants accurately identified their medication condition when receiving active medication (77% of participants), but not when receiving placebo. Concurrent stress-management therapy reduced, but did not eliminate penetration of the blind. Irrespective of drug condition, when participants were improved they were judged to be on active medication and when unimproved they were judged to be on placebo. However, neurologists' ratings of improvement, participants' reports of improvement and daily headache recordings yielded equivalent outcomes. Penetration of the blind needs to be assessed, not assumed in clinical trials in headache. However, penetration of the blind did not produce a prodrug bias as has been asserted by critics. Better methods of assessing and quantifying blindness are needed. PMID: ( Tension Headache ) 16886934 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Potential unblinding of ART study. Acupunct Med. 2006 Mar;24(1):38; author reply 38 Authors: Wettig D PMID: ( Tension Headache ) 16618050 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Treatment of tension-type headache with botox: a review of the literature.
Mt Sinai J Med. 2006 Jan;73(1):493-8 Authors: Rozen D, Sharma J Botulinum toxin has been shown to effectively treat several types of neurological disorders. It has recently been evaluated for the treatment of tension-type headaches in patients who are unable to tolerate or cannot benefit from standard therapies. Most of the open design studies seem to present positive results. However, the randomized, double-blind, placebo-controlled studies present contradictory results for the efficacy of botulinum toxin. Based on these data, further controlled trials of botulinum toxin are needed to evaluate its effects on tension headaches and to determine optimal injection sites, doses, and frequency of treatments. PMID: ( Tension Headache ) 16470328 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Coping with headache.
Scand J Prim Health Care. 2006 Mar;24(1):22-6 Authors: Slettbakk R, Vaksdal Nilsen C, Malterud K OBJECTIVE: To describe self-initiated actions and cognitive strategies used for coping by women who suffer from episodic tension-type headache. DESIGN: Qualitative data from focus-group interviews were analysed according to Giorgi's phenomenological approach, inspired by Lazarus's theory of coping. SUBJECTS: A total of 15 women with tension-type headache, 20-60 years old, were recruited to three different focus groups through newspaper advertising. RESULTS: To cope with episodic tension-type headache, rhythm and balance in actions like eating, drinking, and sleeping were essential. Several women used thermal modulation. Exercise was important. Taking charge of their own time, pace, and level of commitment and accepting the fact that they had to live with their headache were cognitive strategies used. IMPLICATIONS: The general practitioner should identify the woman's choice of actions and cognitive strategies to manage her headache, and support her coping skills. PMID: ( Tension Headache ) 16464811 [PubMed - indexed for MEDLINE ( Tension Headache ) ] The acupuncture randomised trial (ART) for tension-type headache--details of the treatment. Acupunct Med. 2005 Dec;23(4):157-65
Authors: Melchart D, Streng A, Hoppe A, Brinkhaus B, Becker-Witt C, Hammes M, Irnich D, Hummelsberger J, Willich SN, Linde K OBJECTIVE: The goal of this paper is to describe the characteristics of physicians and their interventions in a large, multicentre randomised trial of acupuncture for tension-type headache known as ART TTH, in order to enable acupuncturists to assess the study interventions. METHODS: Participating physicians were recruited whose qualifications met or surpassed those of physicians currently accredited for providing acupuncture by state health funding agencies in Germany. Semi-standardised treatment strategies for acupuncture and minimal acupuncture were developed in a consensus process with acupuncture experts. A total of 270 patients suffering from episodic or chronic tension-type headache were randomised to 12 sessions of semi-standardised acupuncture (three predefined 'basic' points, recommendations for additional points given, but individual choice of additional points possible), standardised minimal acupuncture (superficial needling of at least 5 of 10 predefined, bilateral, distant non-acupuncture points) or a waiting list. Forty two physicians, trained and experienced in acupuncture, from 28 centres in Germany participated in the trial. RESULTS: The median duration of acupuncture training of trial physicians was 500 hours (range 140 to 1350 hours). Physicians had 10 (< 1 to 25) years acupuncture experience. The three 'basic' points (GB20, GB21 and LR3) were treated in 96%, 82% and 97% of sessions, respectively. Frequently treated optional points included LI4 (67%), SP6 (50%) and ST36 (46%). Ten of the 42 physicians stated that they would have treated patients differently outside the trial. The trial found a significant effect of acupuncture over waiting list but not over minimal acupuncture. CONCLUSIONS: In general, trial physicians complied well with the predefined interventions. A relevant minority of participating trial physicians stated that they would have treated patients differently outside the trial. PMID: ( Tension Headache ) 16430123 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Information from your family doctor. Tension-headaches: what you should know. Am Fam Physician. 2005 Nov 1;72(9):1815
Authors: PMID: ( Tension Headache ) 16300043 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Migraine and tension headache--a complementary and alternative medicine approach. Aust Fam Physician. 2005 Aug;34(8):647-51 Authors: Woolhouse M
BACKGROUND: Migraine and tension headache are common--affecting up to 10% and 40% of the Australian population respectively--and result in significant reduction in social activities and work capacity for sufferers. OBJECTIVE: This article considers the evidence for the use of a range of complementary therapies and treatment in the prevention and management of both migraine and tension headache. DISCUSSION: Migraine and tension headache can have many precipitating factors. Considering dietary and environmental factors complements a migraine/headache consultation. There is evidence for the role of mind-body approaches, nutritional supplements such as riboflavin and magnesium, and acupuncture in the treatment of headache. By using a holistic approach we may be able to tailor a treatment program that is both effective and safe. PMID: ( Tension Headache ) 16113701 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ. 2005 Aug 13;331(7513):376-82 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. PMID: ( Tension Headache ) 16055451 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
The effects of laser acupuncture on chronic tension headache--a randomised controlled trial. Acupunct Med. 2005 Mar;23(1):13-8 Authors: Ebneshahidi NS, Heshmatipour M, Moghaddami A, Eghtesadi-Araghi P
OBJECTIVE: Headache affects the quality of life for many people throughout the world. Tension headache is among the commonest forms. Acupuncture is the most widely practised non-medicinal treatment for headaches. The purpose of this study was to explore the effects of laser acupuncture in this type of headache. METHODS: Fifty patients with chronic tension-type headache were randomly allocated to treatment or placebo groups. Patients in the treatment group received low energy laser acupuncture to LU7, LI4, GB14, and GB20 bilaterally. Points were irradiated for 43 seconds, and the intensity was 1.3J (approximately 13J/cm2). Ten sessions were given, three per week. The placebo group was treated in a similar way except that the output power of the equipment was set to zero. The outcome variables were headache intensity (VAS), duration of attacks, and number of days with a headache per month, by daily diary, assessed monthly to three months after treatment. RESULTS: There were significant differences between groups (P<0.001) in changes from baseline in months one, two and three, in median score for headache intensity (treatment group -5, -3 and -2, placebo group -1, 0 and 0), median duration of attacks (treatment group -6, -4 and -4, placebo group -1, 0 and 0 hours), and median number of days with headache per month (treatment group -15, -10 and -8, placebo group -2, 0 and 0). CONCLUSION: This study suggests that laser acupuncture may be an effective treatment for chronic tension-type headache, but the results should be confirmed in larger and more rigorous trials. PMID: ( Tension Headache ) 15844435 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
The treatment of migraines and tension-type headaches with intravenous and oral niacin (nicotinic acid): systematic review of the literature. Nutr J. 2005;4:3
Authors: Prousky J, Seely D BACKGROUND: Migraine and tension-type headaches impose a tremendous economic drain upon the healthcare system. Intravenous and oral niacin has been employed in the treatment of acute and chronic migraine and tension-type headaches, but its use has not become part of contemporary medicine, nor have there been randomized controlled trials further assessing this novel treatment. We aimed to systematically review the evidence of using intravenous and/or oral niacin as a treatment for migraine headaches, tension-type headaches, and for headaches of other etiologic types. METHODS: We searched English and non-English language articles in the following databases: MEDLINE (1966-February 2004), AMED (1995-February 2004) and Alt HealthWatch (1990-February 2004). RESULTS: Nine articles were found to meet the inclusion criteria and were included in this systematic review. Hypothetical reasons for niacin's effectiveness include its vasodilatory properties, and its ability to improve mitochondrial energy metabolism. Important side effects of niacin include flushing, nausea and fainting. CONCLUSION: Although niacin's mechanisms of action have not been substantiated from controlled clinical trials, this agent may have beneficial effects upon migraine and tension-type headaches. Adequately designed randomized trials are required to determine its clinical implications. PMID: ( Tension Headache ) 15673472 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Prospective, randomised, double blind, controlled comparison of metoclopramide and pethidine in the emergency treatment of acute primary vascular and tension type headache episodes. Emerg Med J. 2004 May;21(3):323-6
Authors: Cicek M, Karcioglu O, Parlak I, Ozturk V, Duman O, Serinken M, Guryay M STUDY OBJECTIVE: To compare analgesic effects of metoclopramide (MTP), pethidine (PET), and combination of metoclopramide-pethidine (M-PET) in the treatment of adult patients with acute primary vascular and tension type headache admitted in the emergency department (ED). METHODS: All consecutive adult patients admitted into a university hospital ED in six months with acute vascular and tension type headache were recruited. The patients whose complaints had lasted no longer than seven days were randomised to four groups and thereby received 10 mg MTP intravenously plus placebo intramuscularly (MTP), 10 mg MTP intravenously plus 50 mg PET intramuscularly (M-PET), 50 mg PET intramuscularly plus placebo intravenously (PET); and intramuscular and intravenous placebo (PLC) in a blinded fashion. The patients were asked to report the degree of pain at 0, 15, 30, and 45 minutes on visual analogue scale (VAS) and demographic data and any side effects encountered were recorded. Rescue medication was used if required by the patient because of poor pain relief. RESULTS: Data regarding 336 patients meeting inclusion criteria were analysed. Mean VAS values recorded at 45 minutes were significantly higher in PLC group than in others (p = 0.000). When the PLC group was excluded, VAS scores in MTP and M-PET groups were significantly lower than in PET group (p = 0.038). Though unimportant, the incidence of side effects recorded in PET group was found to be significantly higher than in the other groups (p = 0.003). CONCLUSION: These data suggest that MTP produces more effective analgesia than PET in both vascular and tension type headache in patients with acute primary headache episodes. PMID: ( Tension Headache ) 15107371 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Initial misdiagnosis and outcome after subarachnoid hemorrhage. JAMA. 2004 Feb 18;291(7):866-9
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. PMID: ( Tension Headache ) 14970066 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Vascular endothelial growth factor (VEGF) is increased in serum, but not in cerebrospinal fluid in HIV associated CNS diseases. J Neurol Neurosurg Psychiatry. 2004 Feb;75(2):298-300
Authors: Sporer B, Koedel U, Paul R, Eberle J, Arendt G, Pfister HW Vascular endothelial growth factor (VEGF) is a potent angiogenic and mitogenic peptide, which also induces several mediators that may play a role in HIV induced CNS damage. VEGF levels were determined in cerebrospinal fluid (CSF) and serum samples from patients with (n = 8) and without (n = 19) directly HIV associated CNS disorders and HIV negative control patients (n = 18). VEGF serum but not CSF levels were significantly increased in HIV infected patients with (381.1 (78.9) pg/ml) HIV associated CNS diseases compared with those without (120.8 (13.1) pg/ml) and HIV negative control patients (133.1(14.8) pg/ml). Serum samples from patients with untreated HIV associated encephalopathy (HIVE, n = 3) contained the highest VEGF levels (583.9 (71.5) pg/ml). In two patients VEGF serum levels were reduced during antiretroviral therapy. However, regardless of effective viral suppression, patients with HIVE still had higher levels compared with HIV infected patients without HIVE. A relevant increase of serum VEGF was not observed in patients without HIVE though high HI viral load. We conclude that HIVE is associated with increased serum VEGF levels. Further studies are warranted to elucidate the role of VEGF in HIVE. PMID: ( Tension Headache ) 14742610 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Treating chronic tension-type headache not responding to amitriptyline hydrochloride with paroxetine hydrochloride: a pilot evaluation. Headache. 2003 Oct;43(9):999-1004
Authors: Holroyd KA, Labus JS, O'Donnell FJ, Cordingley GE CONTEXT: In some individuals, chronic tension-type headache fails to respond to tricyclic antidepressant medications that often serve as first-line therapy. OBJECTIVE: To evaluate the clinical efficacy of paroxetine hydrochloride for chronic tension-type headache not responding to amitriptyline hydrochloride. DESIGN AND SETTING: Open-label trial of paroxetine conducted at 2 outpatient sites in Ohio. PARTICIPANTS AND INTERVENTION: Thirty-one adults (mean age, 37 years; 20 women) with chronic tension-type headache (mean, 25 headache days per month) who had failed to respond (less than 30% improvement) to treatment with either amitriptyline (n = 13) or matched placebo (n = 18). All participants were treated with paroxetine (up to 40 mg per day) in a 9-month protocol. OUTCOME MEASURES: Monthly headache index calculated as the mean of pain ratings (0 to 10 scale) recorded by participants in a diary 4 times per day, number of days per month with at least moderate pain (pain rating of 5 or greater), and analgesic medication use. RESULTS: In patients who had not responded to amitriptyline, paroxetine failed to reduce chronic tension-type headaches or analgesic medication use. In patients who had not responded to placebo, paroxetine produced modest reductions in chronic tension-type headaches and analgesic use. CONCLUSIONS: We found no evidence that chronic tension-type headaches that failed to respond to tricyclic antidepressant therapy with amitriptyline improved when subsequently treated with paroxetine. More support was found for the efficacy of paroxetine in patients with chronic tension-type headaches who had failed to respond to placebo. PMID: ( Tension Headache ) 14511278 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Intravenous dipyrone for the acute treatment of episodic tension-type headache: a randomized, placebo-controlled, double-blind study. Braz J Med Biol Res. 2002 Oct;35(10):1139-45
Authors: Bigal ME, Bordini CA, Speciali JG Acute headaches are responsible for a significant percentage of the case load at primary care units and emergency rooms in Brazil. Dipyrone (metamizol) is easily available in these settings, being the most frequently used drug. We conducted a randomized, placebo-controlled, double-blind study to assess the effect of dipyrone in the acute treatment of episodic tension-type headache. Sixty patients were randomized to receive placebo (intravenous injection of 10 ml saline) or 1 g dipyrone in 10 ml saline. We used seven parameters of analgesic evaluation. The patients receiving dipyrone showed a statistically significant improvement (P<0.05) of pain compared to placebo up to 30 min after drug administration. The therapeutic gain was 30% in 30 min and 40% in 60 min. The number of patients needed to be treated for at least one to have benefit was 3.3 in 30 min and 2.2 in 60 min. There were statistically significant reductions in the recurrence (dipyrone = 25%, placebo = 50%) and use of rescue medication (dipyrone = 20%, placebo = 47.6%) for the dipyrone group. Intravenous dipyrone is an effective drug for the relief of pain in tension-type headache and its use is justified in the emergency room setting. PMID: ( Tension Headache ) 12424485 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Massage therapy and frequency of chronic tension headaches.
Am J Public Health. 2002 Oct;92(10):1657-61 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. PMID: ( Tension Headache ) 12356617 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Information from your family doctor. Tension headaches.
Am Fam Physician. 2002 Sep 1;66(5):805 Authors: PMID: ( Tension Headache ) 12322771 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Tension-type headache. Am Fam Physician. 2002 Sep 1;66(5):797-804
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. PMID: ( Tension Headache ) 12322770 [PubMed - indexed for MEDLINE ( Tension Headache ) ] Tension-type headache a challenge for family physicians. Am Fam Physician. 2002 Sep 1;66(5):728, 730, 733 Authors: Walling AD
PMID: ( Tension Headache ) 12322765 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Intravenous chlorpromazine in the acute treatment of episodic tension-type headache: a randomized, placebo controlled, double-blind study. Arq Neuropsiquiatr. 2002 Sep;60(3-A):537-41 Authors: Bigal ME, Bordini CA, Speciali JG
Acute headache is a very frequent symptom, responsible for a significant percentage of caseload at primary care units and emergency rooms. Chlorpromazine is easily available in such settings. The aim of this study is to conduct a randomized, placebo-controlled, double-blind study to assess the efficacy of chlorpromazine on the acute treatment of episodic tension-type headache. We randomized 30 patients to receive placebo (10 ml of saline intravenous injections) and 30 patients to receive 0.1 mg/Kg chlorpromazine intravenously. We used 7 parameters of analgesic evaluation. Patients receiving chlorpromazine showed a statistically significant improvement (p < 0.05 and p < 0.01) of pain compared to placebo, far up to 30 minutes after the drug administration. The therapeutic gain was 36.7% in 30 minutes and 56.6 % in 60 minutes. The number needed to treat (NNT, the reciprocal or the therapeutic gain) was 2.7 in 30 minutes and 1.8 in 60 minutes. There were reductions in the recurrence and in the use of rescue medication in the chlorpromazine group. We can conclude that intravenous chlorpromazine is an effective drug to relief the pain in tension-type headache. PMID: ( Tension Headache ) 12244386 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Chronic daily headache. J Neurol Neurosurg Psychiatry. 2002 Jun;72 Suppl 2:ii2-ii5
Authors: Goadsby PJ, Boes C PMID: ( Tension Headache ) 12122193 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Headache in primary care: how important is diagnosis to management? Br J Gen Pract. 2002 Jul;52(480):569-73
Authors: O'Flynn N, Ridsdale L Headache is a common presentation in primary care. The classification of headache was overhauled by the International Headache Society (IHS) in 1988, and the past decade has seen rapid growth in the understanding of headache disorders. The IHS places particular importance on precise headache diagnosis. This paper discusses the relevance of such an approach to primary care. A review of the literature revealed a dearth of evidence regarding headache management in primary care settings. The evidence from other settings is considered and gaps in the literature highlighted. PMID: ( Tension Headache ) 12120731 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
To use or not to use dipyrone? Sao Paulo Med J. 2002 Mar 7;120(2):63
Authors: Bigal ME PMID: ( Tension Headache ) 11994777 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Trigger points: diagnosis and management. Am Fam Physician. 2002 Feb 15;65(4):653-60 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. PMID: ( Tension Headache ) 11871683 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
In vivo evidence of altered skeletal muscle blood flow in chronic tension-type headache. Brain. 2002 Feb;125(Pt 2):320-6 Authors: Ashina M, Stallknecht B, Bendtsen L, Pedersen JF, Galbo H, Dalgaard P, Olesen J
Painful impulses from tender pericranial muscles may play a major role in the pathophysiology of chronic tension-type headache. Firm evidence for peripheral muscle pathology as a cause of muscle pain and chronic headache is still lacking. Using a microdialysis technique, we aimed to estimate in vivo blood flow and interstitial lactate concentrations in the trapezius muscle at rest and during static exercise in patients with chronic tension-type headache and in healthy subjects. We recruited 16 patients with chronic tension-type headache and 17 healthy control subjects. Two microdialysis catheters were inserted into the trapezius muscle (on the non-dominant side) of subjects, and dialysates were collected at rest, 15 and 30 min after the start of static exercise (10% of maximal force) and 15 and 30 min after the exercise was completed. All samples were coded and analysed blind. The primary endpoints were to detect a difference between patients and controls in changes of muscle blood flow and the interstitial lactate concentration from baseline to exercise and post-exercise periods. The increase in muscle blood flow from baseline to exercise and post-exercise periods was significantly lower in patients than controls (P = 0.03). There was no difference in resting blood flow between patients and controls (P = 0.43). Resting interstitial concentration of lactate did not differ between patients (2.51 +/- 0.18 mM; mean +/- standard error of the mean) and controls (2.35 +/- 0.23 mM, P = 0.57). There was no difference in change in interstitial lactate from baseline to exercise and post-exercise periods between patients and controls (P = 0.38). The present study provides in vivo evidence of decreased blood flow in response to static exercise in a tender muscle in patients with chronic tension-type headache. We suggest that, because of increased excitability of neurones in the CNS, the central interpretation and response to normal sensory input are altered in patients with chronic tension-type headache. This may lead to enhanced sympathetically mediated vasoconstriction and thereby a decreased blood flow in response to static exercise. PMID: ( Tension Headache ) 11844732 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Headache evaluation and treatment by primary care physicians in an emergency department in the era of triptans. Arch Intern Med. 2001 Sep 10;161(16):1969-73 Authors: Maizels M
BACKGROUND: Despite advances in treatment, patients with migraine have been underdiagnosed and undertreated. METHODS: Documentation of visits by patients with headache to an urgent care department staffed by primary care physicians was reviewed. Patients were also sent a brief headache screen, and those who replied were interviewed by telephone. "Repeaters" (patients who made 3 or more visits in 6 months) were excluded from chart review. RESULTS: Over 6 months, 518 patients made 1004 visits to the emergency department for primary headache complaints: 464 patients (90%) made 1 or 2 visits (total visits, 502). A review of 174 charts documenting a diagnosis of migraine found that (1) the need for prophylaxis was determined in only 40 (31%) of the patients who were not already undergoing prophylaxis and (2) treatment in the emergency department was migraine specific in 46 patients (26%) or otherwise appropriate in 45 (25%). A review of 90 charts documenting nonmigraine diagnoses found that 30 patients (33%) had adequate history documented to exclude migraine as the diagnosis. Eighty-six patients (17%) were interviewed. An emergency department diagnosis of migraine (n = 59) corresponded to a final diagnosis of migraine with (n = 21) or without (n = 18) medication overuse or chronic daily headache and/or transformed migraine with (n = 18) or without (n = 2) medication overuse. Discharge diagnoses that were not migraine (n = 27) had final diagnoses of migraine with (n = 9) or without (n = 9) medication overuse or chronic daily headache/transformed migraine with (n = 7) or without (n = 2) medication overuse. CONCLUSIONS: In this emergency department population, many patients with migraine, chronic daily headache, or medication overuse are not accurately diagnosed. The need for prophylaxis is not usually assessed. Treatment is migraine specific in the minority of patients. Tension-type headache is rarely an accurate diagnosis in this emergency department population. PMID: ( Tension Headache ) 11525699 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
No difference between acupuncture and sham in chronic tension-type headache (n=39). Acupunct Med. 2001 Jun;19(1):51-3 Authors: Cummings M
PMID: ( Tension Headache ) 11471585 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
JAMA patient page. Tension headache. JAMA. 2001 May 2;285(17):2282 Authors:
PMID: ( Tension Headache ) 11368044 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA. 2001 May 2;285(17):2208-15 Authors: Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW
CONTEXT: Chronic tension-type headaches are characterized by near-daily headaches and often are difficult to manage in primary practice. Behavioral and pharmacological therapies each appear modestly effective, but data are lacking on their separate and combined effects. OBJECTIVE: To evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for chronic tension-type headaches. DESIGN AND SETTING: Randomized placebo-controlled trial conducted from August 1995 to January 1998 at 2 outpatient sites in Ohio. PARTICIPANTS: Two hundred three adults (mean age, 37 years; 76% women) with diagnosis of chronic tension-type headaches (mean, 26 headache d/mo). INTERVENTIONS: Participants were randomly assigned to receive tricyclic antidepressant (amitriptyline hydrochloride, up to 100 mg/d, or nortriptyline hydrochloride, up to 75 mg/d) medication (n = 53), placebo (n = 48), stress management (eg, relaxation, cognitive coping) therapy (3 sessions and 2 telephone contacts) plus placebo (n = 49), or stress management therapy plus antidepressant medication (n = 53). MAIN OUTCOME MEASURES: Monthly headache index scores calculated as the mean of pain ratings (0-10 scale) recorded by participants in a daily diary 4 times per day; number of days per month with at least moderate pain (pain rating >/=5), analgesic medication use, and Headache Disability Inventory scores, compared by intervention group. RESULTS: Tricyclic antidepressant medication and stress management therapy each produced larger reductions in headache activity, analgesic medication use, and headache-related disability than placebo, but antidepressant medication yielded more rapid improvements in headache activity. Combined therapy was more likely to produce clinically significant (>/=50%) reductions in headache index scores (64% of participants) than antidepressant medication (38% of participants; P =.006), stress management therapy (35%; P =.003), or placebo (29%; P =.001). On other measures the combined therapy and its 2 component therapies produced similar outcomes. CONCLUSIONS: Our results indicate that antidepressant medication and stress management therapy are each modestly effective in treating chronic tension-type headaches. Combined therapy may improve outcome relative to monotherapy. PMID: ( Tension Headache ) 11325322 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Nitric oxide-induced headache in patients with chronic tension-type headache. Brain. 2000 Sep;123 ( Pt 9):1830-7
Authors: Ashina M, Bendtsen L, Jensen R, Olesen J An experimental model of headache offers unique possibilities to study the mechanisms responsible for head pain. Using the glyceryl trinitrate [GTN; nitric oxide (NO) donor] model of experimental headache, we studied the intensity, quality and time profile of headache after infusion of GTN in 16 patients with chronic tension-type headache and in 16 healthy controls. Subjects were randomized to receive intravenous infusion of GTN (0.5 microg/kg per minute for 20 min) or placebo on two headache-free days separated by at least 1 week. Headache intensity was measured on a 10-point verbal rating scale during 2 h of observation and for the next 10 h after discharge from hospital. The primary endpoints were the difference between the area under the curve (AUC-intensities x duration) for headache recorded on the day of GTN treatment and on the day of placebo treatment in patients, and in patients and controls on the days of GTN treatment. In patients, the AUC on a GTN day [2221 (1572-3704); median with quartiles in parentheses], was significantly greater than on a placebo day [730 (60-1678), P: = 0. 008]. On the GTN day, the AUC in patients [2221 (1572-3704)] was significantly higher than in controls [43 (0-972), P: = 0.0001]. In patients, peak pain intensity occurred 8 h after infusion of GTN, whereas in controls it occurred 20 min after the start of infusion. The present study demonstrates that an NO-induced biphasic response with an immediate and a delayed headache is common to chronic tension-type headache and migraine. Furthermore, the NO-induced delayed headache has the characteristics of the primary headache disorder. This suggests that NO contributes to the mechanisms of several types of primary headaches and that NO-related central sensitization may be an important common denominator in the pain mechanisms of primary headaches. PMID: ( Tension Headache ) 10960046 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Possible mechanisms of action of nitric oxide synthase inhibitors in chronic tension-type headache. Brain. 1999 Sep;122 ( Pt 9):1629-35
Authors: Ashina M, Bendtsen L, Jensen R, Lassen LH, Sakai F, Olesen J It has been demonstrated recently that nitric oxide synthase (NOS) inhibition has an analgesic effect in patients with chronic tension-type headache. The aim of the present study was to investigate the influence of the NOS inhibitor, L-N(G) methyl arginine hydrochloride (L-NMMA), on two of the most prominent features of chronic tension-type headache, i.e. increased muscle hardness and increased myofascial tenderness. In a double blind, crossover designed trial, 16 patients with chronic tension-type headache were randomized to receive intravenous infusion of 6 mg/kg L-NMMA or placebo on 2 days separated by at least 1 week. Muscle hardness of the trapezius muscle was measured with a hardness meter. Myofascial tenderness in the pericranial region was evaluated by manual palpation with standardized and validated methodology. All parameters were recorded at baseline and at 60 and 120 min after start of infusion. Compared with baseline, muscle hardness, 107 +/- 17 kPa/cm and tenderness, 18 +/- 11 were significantly reduced at 60 and 120 min to: hardness, 101 +/- 17 kPa/cm and 101 +/- 17 kPa/cm, respectively; tenderness, 15 +/- 11 and 14 +/- 11, respectively, after treatment with L-NMMA (P < 0.05 and P < 0.01, respectively), while there was no significant reduction at any time after treatment with the placebo. Compared with the placebo, the summary score of muscle hardness was significantly reduced (P = 0.04), while tenderness showed a non-significant reduction (P = 0.11) following treatment with L-NMMA. Since increased muscle hardness in patients with chronic tension-type headache may reflect sensitization of second order neurons due to prolonged nociceptive input from myofascial tissues, we suggest that the decrease in muscle hardness following treatment with L-NMMA may be caused by reduction of central sensitization. PMID: ( Tension Headache ) 10468503 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Chronic tension-type headache: where are we?
Brain. 1999 Sep;122 ( Pt 9):1611-2 Authors: Goadsby PJ PMID: ( Tension Headache ) 10468501 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial.
JAMA. 1998 Nov 11;280(18):1576-9 Authors: Bove G, Nilsson N CONTEXT: Episodic tension-type headache is common and is often treated using manual therapies. Few data exist for the efficacy of these interventions. OBJECTIVE: To determine the effects of spinal manipulation therapy on adults with episodic tension-type headache. DESIGN: Randomized controlled trial lasting 19 weeks. SETTING: Outpatient facility of a National Health Service-funded chiropractic research institution in Denmark. PARTICIPANTS: Volunteer sample of 26 men and 49 women aged 20 to 59 years who met the diagnostic criteria for episodic tension-type headache as defined by the International Headache Society. INTERVENTION: Participants were randomized into 2 groups, 1 receiving soft tissue therapy and spinal manipulation (the manipulation group), and the other receiving soft tissue therapy and a placebo laser treatment (the control group). All participants received 8 treatments over 4 weeks; all treatments were performed by the same chiropractor. MAIN OUTCOME MEASURES: Daily hours of headache, pain intensity per episode, and daily analgesic use, as recorded in diaries. RESULTS: Based on intent-to-treat analysis, no significant differences between the manipulation and control groups were observed in any of the 3 outcome measures. However, by week 7, each group experienced significant reductions in mean daily headache hours (manipulation group, reduction from 2.8 to 1.5 hours; control group, reduction from 3.4 to 1.9 hours) and mean number of analgesics per day (manipulation group, reduction from 0.66 to 0.38; control group, reduction from 0.82 to 0.59). These changes were maintained through the observation period. Headache pain intensity was unchanged for the duration of the trial. CONCLUSION: As an isolated intervention, spinal manipulation does not seem to have a positive effect on episodic tension-type headache. PMID: ( Tension Headache ) 9820258 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
What counts as evidence? A personal odyssey into alternative care.
Arch Fam Med. 1998 Nov-Dec;7(6):598-9 Authors: Richard D PMID: ( Tension Headache ) 9821838 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
The clinician's approach to the management of headache.
West J Med. 1998 Mar;168(3):203-12 Authors: Maizels M Headache is a ubiquitous complaint, yet it is one that often elicits anxiety in both patients and physicians. When a patient presents with headache, the clinician must answer the following questions: (1) Is the headache "worrisome" (secondary to underlying disease)? (2) If the headache is benign, what type is it? (3) How is the acute headache best treated? and (4) How may future headaches be prevented? The following review is intended to aid primary care physicians in answering these questions. PMID: ( Tension Headache ) 9549429 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
The efficacy of selective serotonin reuptake inhibitors for the management of chronic pain.
J Gen Intern Med. 1997 Jun;12(6):384-9 Authors: Jung AC, Staiger T, Sullivan M OBJECTIVE: To assess the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in the management of chronic pain. METHODS: Randomized, controlled trials of SSRIs in the management of chronic pain were identified by searching MEDLINE from 1966 to 1997 and by contacting the manufacturers of SSRIs available in the United States. MAIN RESULTS: Nineteen studies were identified, including 10 on the treatment of headache, 3 on diabetic neuropathy, 3 on fibromyalgia, and 3 on mixed-chronic pain. SSRIs were consistently helpful for mixed-chronic pain. Results were conflicting for migraine headache, tension headache, diabetic neuropathy, and fibromyalgia. CONCLUSIONS: SSRIs appear to be beneficial for mixed-chronic pain. It is unclear, from the available evidence, whether SSRIs are beneficial for migraine headaches, tension headaches, diabetic neuropathy, or fibromyalgia. For those patients it may be reasonable to reserve SSRIs for those who fall to respond to other medications or who are intolerant of their side effects. PMID: ( Tension Headache ) 9192257 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
To what extent do clinical notes by general practitioners reflect actual medical performance? A study using simulated patients.
Br J Gen Pract. 1994 Apr;44(381):153-6 Authors: Rethans JJ, Martin E, Metsemakers J BACKGROUND. Review of clinical notes is used extensively as an indirect method of assessing doctors' performance. However, to be acceptable it must be valid. AIM. This study set out to examine the extent to which clinical notes in medical records of general practice consultations reflected doctors' actual performance during consultations. METHOD. Thirty nine general practitioners in the Netherlands were consulted by four simulated patients who were indistinguishable from real patients and who reported on the consultations. The complaints presented by the simulated patients were tension headache, acute diarrhoea and pain in the shoulder, and one presented for a check up for non-insulin dependent diabetes. Later, the doctors forwarded their medical records of these patients to the researchers. Content of consultations was measured against accepted standards for general practice and then compared with content of clinical notes. An index, or content score, was calculated as the measure of agreement between actions which had actually been recorded and actions which could have been recorded in the clinical notes. A high content score reflected a consultation which had been recorded well in the medical record. The correlation between number of actions across the four complaints recorded in the clinical notes and number of actions taken during the consultations was also calculated. RESULTS. The mean content score (interquartile range) for the four types of complaint was 0.32 (0.27-0.37), indicating that of all actions undertaken, only 32% had been recorded. However, mean content scores for the categories 'medication and therapy' and 'laboratory examination' were much higher than for the categories 'history' and 'guidance and advice' (0.68 and 0.64, respectively versus 0.29 and 0.22, respectively). The correlation between number of actions across the four complaints recorded in the clinical notes and number of actions taken during the consultations was 0.54 (P < 0.05). CONCLUSION. The use of clinical notes to audit doctors' performance in Dutch general practice is invalid. However, the use of clinical notes to rank doctors according to those who perform many or a few actions in a consultation may be justified. PMID: ( Tension Headache ) 8185988 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Muscle relaxation techniques: a therapeutic tool for family physicians. Can Med Assoc J. 1984 Mar 15;130(6):691-4 Authors: Rapp MS, Thomas MR, Leith MG Muscle relaxation techniques are important adjunctive therapy for anxiety-related conditions. Family physicians can learn to teach the techniques so as to try helping anxious patients themselves rather than automatically referring them to a psychiatrist. The exercises are generally acceptable to patients, are easy to learn and do not require expensive equipment. They are beneficial in insomnia and tension headache, of some value in chronic anxiety states and a useful adjunct in hypertension. In this paper the evidence supporting the value of muscle relaxation therapy is briefly reviewed, methods of teaching and of practising the techniques are described in detail, and answers to some of the questions and problems that may arise are presented. PMID: ( Tension Headache ) 6365300 [PubMed - indexed for MEDLINE ( Tension Headache ) ]
Practice settings and prescribing profiles: the simulation of tension headaches to general practitioners working in different practice settings in the Montreal area. Am J Public Health. 1980 Oct;70(10):1068-73 Authors: Renaud M, Beauchemin J, Lalonde C, Poirier H, Berthiaume S The purpose of this study was to determine whether physicians practicing in one type of setting manage a medical problem differently than those practicing in another type of setting. The investigation took the form of presenting physicians with a simulated case of tension headache with a history going back three years, for which diazepam had been taken daily for the past year. Four simulated patients (aged 20-23) visited a stratified random sample of 111 general practitioners practicing in health centers funded by government (CLSCs) and in private group practice clinics in the Montreal area. Fifty-one per cent of group practice physicians recommended therapy rated as "inadequate" compared to 25 per cent in CLSCs; in addition, the data show significant differences between CLSC and group practice physicians in performing various aspects of the clinical examination. Alternative explanations for the observed differences are discussed. PMID: ( Tension Headache ) 6106399 [PubMed - indexed for MEDLINE] |
