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Cephalalgia : An International Journal... Mar 2023A systematic and meta-analysis was conducted to examine the evidence of the effects of botulinum toxin A on chronic tension-type headache. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A systematic and meta-analysis was conducted to examine the evidence of the effects of botulinum toxin A on chronic tension-type headache.
METHODS
Cochrane, Embase, Ovid, ProQuest, PubMed, Scopus, Web-of-Science databases, and ClinicallTrials.gov registry were systematically searched for studies examining the effects of botulinum toxin A on tension-type headaches. The records were screened by two independent reviewers using pre-determined eligibility criteria. DerSimonian Liard random-effects meta-analyses were performed using the 'meta' package (5.2-0) in R (4.2.0). Risk of bias and quality of evidence were assessed using the Cochrane Collaboration's Tool RoB 2 and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Clinical significance was determined using pre-defined minimal clinically important differences.
RESULTS
Eleven controlled trials were included (390 botulinum toxin A, 297 controls). Botulinum toxin A was associated with significant improvements in standardized headache intensity (-0.502 standard deviations [-0.945, -0.058]), headache frequency (-2.830 days/month [-4.082, -1.578]), daily headache duration (-0.965 [-1.860, -0.069]) and the frequency of acute pain medication use (-2.200 days/month [-3.485, -0.915]) vs controls. Botulinum toxin A-associated improvements exceeded minimal clinically important differences for headache intensity, frequency, and acute pain medication use. A 79% (28%, 150%) greater response rate was observed for botulinum toxin A vs controls in improving chronic tension-type headache. Treatment of eight chronic tension-type headache patients was sufficient to elicit a therapeutic response in one patient.
CONCLUSIONS
Corroborating the current mechanistic evidence, our meta-analysis supports the utility of botulinum toxin A for managing chronic tension-type headaches. However, due to limitations in the quality of evidence, adequately-powered high-quality controlled trials examining the effects of Botulinum toxin A on chronic tension-type headache are warranted.
REGISTRATION
Protocol preregistered in PROSPERO International Prospective Register of Systematic Reviews (CRD42020178616).
Topics: Humans; Tension-Type Headache; Botulinum Toxins, Type A; Acute Pain; Headache; Headache Disorders
PubMed: 36786349
DOI: 10.1177/03331024221150231 -
Headache Jul 2022We conducted a systematic review and dose-response meta-analysis to investigate the association between body mass index (BMI) and primary headache disorder subtypes and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We conducted a systematic review and dose-response meta-analysis to investigate the association between body mass index (BMI) and primary headache disorder subtypes and to clarify the shape of this relationship.
METHODS
PubMed and Scopus were searched from inception to September 2020. Observational studies reporting the risk estimates of primary headache disorders across categories of BMI were included. We restricted our systematic search to articles published in English. Meta-analyses, reviews, letters to editor, case reports/case series, and abstracts with inadequate data were excluded. We used the Joanna Briggs Institute's critical appraisal tool to assess the quality of the studies included in the meta-analyses. One author extracted data from each study by using prespecified data extraction forms.
RESULTS
In total, 41 observational studies investigating the association between BMI and different primary headache disorders with 154,044 cases and 792,500 participants were included. Among subtypes of headache disorders, the risk of migraine significantly increased in subjects who were either underweight or had obesity compared to those with normal BMI (odds ratio [OR] = 1.21, 95% confidence interval [CI]: 1.09-1.34, I = 6.2%; OR = 1.28, 95% CI: 1.15-1.43, I = 89.7%, respectively). However, there was limited evidence to support the association between BMI and the risk of other subtypes of primary headache disorders. A nonlinear association was found between BMI and migraine (p nonlinearity <0.0001), and the lowest risk was observed in BMI around 20 and increased at BMI values >29.
CONCLUSION
This meta-analysis suggests through a nonlinear association an increased risk of migraine among individuals who are either underweight or obese. These results support the recommendation that headache disorders' prevention will benefit from weight control.
Topics: Body Mass Index; Headache; Humans; Migraine Disorders; Obesity; Thinness
PubMed: 35851952
DOI: 10.1111/head.14356 -
Acta Neurologica Belgica Jun 2023Headache is a disabling disease that affects psychosocial factors. Medical students are recognized to be more susceptible to psychological stress than other.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Headache is a disabling disease that affects psychosocial factors. Medical students are recognized to be more susceptible to psychological stress than other. Quantitative summaries of prevalence studies on this subject are limited. The aim of this study was to quantify and comprehend the variance in prevalence at the global and regional levels.
METHODS
We used a comprehensive search approach to find studies on headaches prevalence in the medical literature published between November 1990 and May 5, 2022. Database searched were PubMed, Scopus, EMBASE, and Google Scholar. Studies that reported headaches (unspecified, migraine, or tension-type headache (TTH)) in medical students were included. Subgroup analysis and meta-regression were applied to investigate heterogeneity, with the risk of bias tool employed to assess study quality. PROSPERO number CRD42022321556 was assigned to the study protocol.
RESULTS
Out of 1561 studies, 79 were included. The pooled prevalence estimates of unspecified headache, migraine, and TTH were 70.44% (95% CI: 63.32-77.57), 18.9% (95% CI: 15.7-22.0), and 39.53% (95% CI: 31.17-47.90), respectively. TTH and migraine were more prevalent in Eastern Mediterranean and American region. TTH and migraine were less prevalent in higher income countries.
CONCLUSION
Although the prevalence of headaches among medical students varies in different countries, it is higher than the general population of the same age. Higher stressors and overwork in these students may contribute to this condition. The well-being of medical students should be a priority for the relevant authorities.
Topics: Humans; Students, Medical; Headache; Tension-Type Headache; Migraine Disorders; Disabled Persons; Prevalence
PubMed: 37138039
DOI: 10.1007/s13760-023-02274-2 -
Headache Sep 2019Migraine, tension-type headache, and hypothyroidism constitute very common medical conditions. Headache is one of the most common symptoms of hypothyroidism, occurring...
BACKGROUND
Migraine, tension-type headache, and hypothyroidism constitute very common medical conditions. Headache is one of the most common symptoms of hypothyroidism, occurring in approximately one-third of the patients. To date, data about the relationship between migraine and tension-type headache and thyroid dysfunction, and in particular hypothyroidism have been contradictory, while the underlying pathophysiological basis explaining this association is still unclear.
OBJECTIVE
In this review, we investigated the association between primary headaches and hypothyroidism, with the aim of shedding light on its pathophysiological basis.
METHODS
We conducted a systematic search in the MEDLINE database using both subject headings and keywords for headache, migraine, tension-type headache, thyroid hormones, and hypothyroidism, and we also examined manually the reference lists of all articles that met the inclusion criteria. Included studies were related to headache and thyroid disease comorbidity, with emphasis on hypothyroidism (ideally demonstrated by hormonal measurements), and with the term headache including migraine, tension-type headache, and headache attributed to hypothyroidism (HAH) based on the International Classification of Headache Disorders IIIb. Quality of studies was assessed by the Newcastle-Ottawa scale.
RESULTS
Of a total of 640 identified articles, 9 studies were included. Overall, there was vast heterogeneity across the included studies concerning population, study design and outcomes. Two studies investigated the HAH, with emphasis on the clinical characteristics of headache (time of onset, localization, quality, intensity, and response to hormonal replacement treatment). Five studies investigated comorbidity between migraine and thyroid disorders, especially hypothyroidism, and in the majority of them a positive association was demonstrated. One study found that headache, and particularly migraine, may increase the risk of developing hypothyroidism. Finally, only 1 study on chronic tension-type headache found coexistence of migraine and hypoactivity of the hypothalamus-pituitary-thyroid axis. The strengths and limitations of these studies are analyzed and possible pathophysiological mechanisms are suggested.
CONCLUSIONS
The existing data are considered inadequate to answer with certainty the relationship between headaches and thyroid disorders. According to our analysis, it seems that suggestions for a possible bidirectional association between headaches and especially migraine and hypothyroidism could exist. It hence lays the foundation for further research into the aforementioned association and its pathogenesis via large prospective multicenter studies.
Topics: Humans; Hypothyroidism; Migraine Disorders; Tension-Type Headache
PubMed: 31310335
DOI: 10.1111/head.13600 -
Pain and Therapy May 2024Tension-type headache (TTH) is common but challenging to manage due to limited effectiveness of conventional treatments. This study examines six complementary and... (Review)
Review
INTRODUCTION
Tension-type headache (TTH) is common but challenging to manage due to limited effectiveness of conventional treatments. This study examines six complementary and alternative medicine (CAM) interventions through network meta-analysis to identify effective TTH management strategies.
METHODS
We searched PubMed, Embase, Web of Science, Cochrane Library, OVID, CNKI, Wanfang, VIP, and CBM databases for randomized controlled trials on CAM for TTH treatment. Headache frequency and intensity were the primary outcomes. Methodological quality was evaluated on the basis of the Cochrane risk of bias tool. We used R software to conduct this Bayesian network meta-analysis. We used mean difference (MD) with 95% credible intervals (CI) to calculate the continuous outcomes and analyzed the percentages of the surface under the cumulative ranking (SUCRA) curve.
RESULTS
In total, 32 randomized controlled trials (RCTs) with 2405 participants were analyzed. For reducing headache intensity, the network meta-analysis shows that acupuncture therapy combined with traditional Chinese medicine (AT_TCM), manual therapy (MT), psychological treatment (PT), and traditional Chinese medicine combined with acupuncture and manual therapy (TCM_AT_MT) are superior to Western medicine (WM). In the SUCRA curve, TCM_AT_MT is the best for reducing headache frequency (HF).
CONCLUSIONS
This review, assessed as low-quality evidence by GRADE, cautiously suggests potential benefits of PT over other CAM interventions for TTH and indicates TCM_AT_MT might better reduce HF. It proposes that combining CAM interventions could enhance outcomes. Due to the preliminary nature of these findings, further high-quality RCTs are essential to confirm these suggestions and provide clearer clinical guidance.
PROSPERO REGISTRATION NUMBER
CRD42021252073.
PubMed: 38748200
DOI: 10.1007/s40122-024-00600-x -
Annals of Medicine Dec 2024Tension-type headache is the most common type of primary headache and results in a huge socioeconomic burden. This network meta-analysis (NMA) aimed to compare the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Tension-type headache is the most common type of primary headache and results in a huge socioeconomic burden. This network meta-analysis (NMA) aimed to compare the efficacy and safety of simple analgesics for the treatment of episodic tension-type headache (ETTH) in adults.
METHODS
We searched the Cochrane Library, PubMed, Web of Science, Embase, Chinese BioMedical Literature database and International Clinical Trials Registry Platform databases for eligible randomized clinical trials reporting the efficacy and/or safety of simple analgesics. A Bayesian NMA was performed to compare relative efficacy and safety. The surface under the cumulative ranking curve (SUCRA) was calculated to rank interventions. PROSPERO registration number: CRD42018090554.
RESULTS
We highlighted six studies including 3507 patients. For the 2 h pain-free rate, the SUCRA ranking was ibuprofen > diclofenac-K > ketoprofen > acetaminophen > naproxen > placebo. All drugs except naproxen reported a higher 2 h pain-free rate than placebo, with a risk ratio (RR) of 2.86 (95% credible interval, CrI: 1.62-5.42) for ibuprofen and 2.61 (1.53-4.88) for diclofenac-K. For adverse events rate, the SUCRA ranking was: metamizol > diclofenac-K > ibuprofen > lumiracoxib > placebo > aspirin > acetaminophen > naproxen > ketoprofen. The adverse event rates of all analgesics were no higher than those of placebo, except for ketoprofen. Moreover, all drugs were superior to placebo in the global assessment of efficacy. In particular, the RR of lumiracoxib was 2.47 (1.57-4.57). Global heterogeneity between the studies was low.
CONCLUSIONS
Simple analgesics are considered more effective and safe as a placebo for ETTH in adults. Our results suggest that ibuprofen and diclofenac-K may be the two best treatment options for patients with ETTH from a comprehensive point of view (both high-quality evidence).
Topics: Humans; Tension-Type Headache; Analgesics; Adult; Network Meta-Analysis; Ibuprofen; Acetaminophen; Bayes Theorem; Treatment Outcome; Diclofenac; Randomized Controlled Trials as Topic; Naproxen; Ketoprofen; Anti-Inflammatory Agents, Non-Steroidal; Female; Male
PubMed: 38813682
DOI: 10.1080/07853890.2024.2357235 -
Journal of Oral & Facial Pain and...To answer the question: among observational studies, is there any association between primary headaches and bruxism in adults?
AIMS
To answer the question: among observational studies, is there any association between primary headaches and bruxism in adults?
MATERIALS AND METHODS
A systematic review of observational studies was performed. The search was performed in seven main databases and three gray literature databases. Studies in which samples were composed of adult patients were included. Primary headaches were required to be diagnosed by the International Classification of Headache Disorders. Any diagnostic method for bruxism was accepted. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tool and the Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool. Associations were analyzed by calculating odds ratios (OR) in Review Manager 5.3 software. The evidence certainty was screened by Grading of Recommendations Assessment, Development, and Evaluation criteria.
RESULTS
Of the 544 articles reviewed, 5 met the inclusion criteria for qualitative analysis. The included studies evaluated both awake and sleep bruxism, as well as tension-type headaches and migraines as primary headaches. Among two migraine studies, one showed an OR of 1.79 (95% CI: 0.96 to 3.33) and another 1.97 (95% CI: 1.5 to 2.55). On the other hand, among three tension-type headache studies, there was a positive association only with awake bruxism, with an OR of 5.23 (95% CI: 2.57 to 10.65). All included articles had a positive answer for more than 60% of the risk of bias questions. The evidence certainty varied between low and very low. Due to high heterogeneity among the studies, it was impossible to perform a meta-analysis.
CONCLUSION
Patients with awake bruxism have from 5 to 17 times more chance of having tension-type headaches. Sleep bruxism did not have any association with tension-type headache, and the association with migraines is controversial.
Topics: Adult; Bruxism; Headache; Humans; Migraine Disorders; Observational Studies as Topic; Odds Ratio; Sleep Bruxism; Tension-Type Headache
PubMed: 34129658
DOI: 10.11607/ofph.2745 -
European Child & Adolescent Psychiatry Mar 2018An association between primary headaches and attention-deficit/hyperactivity disorder (ADHD) has long been suggested. Moreover, headache is regarded as a common side... (Meta-Analysis)
Meta-Analysis Review
An association between primary headaches and attention-deficit/hyperactivity disorder (ADHD) has long been suggested. Moreover, headache is regarded as a common side effect of stimulants, the most effective treatment for ADHD. So far, no systematic review has evaluated the potential association between ADHD and headache. We performed a systematic review of the literature and a meta-analysis of all reported studies on ADHD and primary headaches. Our analysis showed a positive association between ADHD and migraine (OR 1.322, 95% CI 1.018-1717, p value 0.036), but not with tension-type headache. There is a significant association between migraine and ADHD. The mechanisms underlying this association remain to be elucidated, warranting further studies.
Topics: Adolescent; Attention Deficit Disorder with Hyperactivity; Child; Child, Preschool; Humans; Migraine Disorders
PubMed: 28905127
DOI: 10.1007/s00787-017-1045-4 -
Medicine Nov 2022Headache disorders are common diseases that cause a social burden. This systematic review and meta-analysis aimed to evaluate the effects of various non-pharmacological... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Headache disorders are common diseases that cause a social burden. This systematic review and meta-analysis aimed to evaluate the effects of various non-pharmacological treatments to address or prevent acute headaches, including neuromodulation, acupuncture, and aerobic exercises in patients with episodic migraine and tension-type headache (TTH).
METHODS
We performed a systematic search of the electronic databases PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WANFANG MEDICINE ONLINE, and Chinese Medical Journal database using Stata/SE 14.0 to obtain weighted mean differences (WMDs). The outcomes included monthly headache days, headache intensity, headache duration, days per month of acute medication use, and the Medical Outcomes Study 36-Item Short-Form Health Survey.
RESULTS
Of 872 identified articles, 27 were included in the meta-analysis. Neuromodulation was associated with reduced headache days (WMD: -1.274, 95% CI [-1.914, -0.634], P < .001), duration (WMD: -2.2, 95% CI [-3.32, -0.107], P < .001) and medication consumption (WMD: -1.808, 95% CI [-2.546, -1.071], P < .001) in cases of migraine. Acupuncture was associated with the alleviation of headache days (WMD: -0.677, 95% CI [-0.932, -0.422], P < .001) and intensity (WMD: -0.893, 95% CI [-1.573, -0.212], P = .01) in cases of migraine and acute medication use (WMD: -3.29, 95% CI [-4.86, -1.72], P < .001) in cases of TTH. Aerobic exercise was associated with reduced headache duration (WMD: -5.1, 95% CI [-8.97, -1.22], P = .01) in cases of TTH. The risk of bias for included articles was moderate.
CONCLUSIONS
There is low- and moderate-quality evidence that neuromodulation, acupuncture, and aerobic exercises are associated with attenuated headache symptoms in patients with episodic migraine or TTH. However, high-quality studies are needed to draw more detailed conclusions.
Topics: Humans; Tension-Type Headache; Migraine Disorders; Acupuncture Therapy; Headache; Exercise
PubMed: 36397322
DOI: 10.1097/MD.0000000000030530 -
The Cochrane Database of Systematic... Jul 2014The original authors of this review are unable to update it. The Cochrane Pain, Palliative and Supportive Care Review Group (PaPaS) is seeking new authors to update and... (Meta-Analysis)
Meta-Analysis Review
The original authors of this review are unable to update it. The Cochrane Pain, Palliative and Supportive Care Review Group (PaPaS) is seeking new authors to update and split the review into two separate reviews on migraine and tension‐type headache. If you are interested, please contact the Managing Editor of PaPaS (contact details provided under 'Contact Person'). At July 2014, this review has been withdrawn. This review is out of date although it is correct as of the date of publication. The latest version is available in the ‘Other versions’ tab on The Cochrane Library, and may still be useful to readers. The editorial group responsible for this previously published document have withdrawn it from publication.
Topics: Acute Disease; Adult; Analgesics, Non-Narcotic; Dipyrone; Headache Disorders, Primary; Humans; Randomized Controlled Trials as Topic
PubMed: 25019294
DOI: 10.1002/14651858.CD004842.pub3