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Nature Reviews. Disease Primers Mar 2021Tension-type headache (TTH) is the most prevalent neurological disorder worldwide and is characterized by recurrent headaches of mild to moderate intensity, bilateral... (Review)
Review
Tension-type headache (TTH) is the most prevalent neurological disorder worldwide and is characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity. Diagnosis is based on headache history and the exclusion of alternative diagnoses, with clinical criteria provided by the International Classification of Headache Disorders, third edition. Although the biological underpinnings remain unresolved, it seems likely that peripheral mechanisms are responsible for the genesis of pain in TTH, whereas central sensitization may be involved in transformation from episodic to chronic TTH. Pharmacological therapy is the mainstay of clinical management and can be divided into acute and preventive treatments. Simple analgesics have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of TTH. Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and if simple analgesics are ineffective, poorly tolerated or contraindicated. Recommended preventive treatments include amitriptyline, venlafaxine and mirtazapine, as well as some selected non-pharmacological therapies. Despite the widespread prevalence and associated disability of TTH, little progress has been made since the early 2000s owing to a lack of attention and resource allocation by scientists, funding bodies and the pharmaceutical industry.
Topics: Analgesics; Humans; Tension-Type Headache
PubMed: 33767185
DOI: 10.1038/s41572-021-00257-2 -
The Medical Clinics of North America Mar 2019Migraine and tension-type headache are highly prevalent. Migraine is associated with significant work- and family-related disability. Migraine is underdiagnosed; it... (Review)
Review
Migraine and tension-type headache are highly prevalent. Migraine is associated with significant work- and family-related disability. Migraine is underdiagnosed; it reasonable to err on the side of migraine when choosing between primary headaches. Barriers to appropriate treatment of migraine include lack of access to providers, misdiagnosis, and acute and preventive therapies not being prescribed. Acute, rescue, and preventive treatment options are extensive, and new classes of treatments are either available or in development. This review addresses diagnostic challenges including recognizing migraine with aura. It also summarizes nonpharmacologic, acute, rescue, and preventive treatment options for migraine and treatment of tension-type headache.
Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Diagnosis, Differential; Female; Humans; Male; Migraine Disorders; Tension-Type Headache; Tryptamines
PubMed: 30704678
DOI: 10.1016/j.mcna.2018.10.003 -
Neurologia Sep 2021Tension-type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely... (Review)
Review
INTRODUCTION
Tension-type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely used in the clinical field to treat the symptoms associated with tension-type headache. This systematic review aims to determine the effectiveness of manual and non-invasive therapies in the treatment of patients with tension-type headache.
DEVELOPMENT
We conducted a systematic review of randomised controlled trials in the following databases: Brain, PubMed, Web of Science, PEDro, Scopus, CINAHL, and Science Direct. Ten randomised controlled trials were included for analysis. According to these studies, manual therapy improves symptoms, increasing patients' well-being and improving the outcome measures analysed.
CONCLUSIONS
Manual therapy has positive effects on pain intensity, pain frequency, disability, overall impact, quality of life, and craniocervical range of motion in adults with tension-type headache. None of the techniques was found to be superior to the others; combining different techniques seems to be the most effective approach.
Topics: Adult; Headache; Humans; Musculoskeletal Manipulations; Post-Traumatic Headache; Quality of Life; Tension-Type Headache
PubMed: 34537167
DOI: 10.1016/j.nrleng.2017.12.005 -
Ideggyogyaszati Szemle Jan 2019Tension type headache, the most common type of primary headaches, affects approximately 80% of the population. Mainly because of its high prevalence, the socio-economic... (Review)
Review
Tension type headache, the most common type of primary headaches, affects approximately 80% of the population. Mainly because of its high prevalence, the socio-economic consequences of tension type headache are significant. The pain in tension type headache is usually bilateral, mild to moderate, is of a pressing or tightening quality, and is not accompanied by other symptoms. Patients with frequent or daily occurrence of tension type headache may experience significant distress because of the condition. The two main therapeutic avenues of tension type headache are acute and prophylactic treatment. Simple or combined analgesics are the mainstay of acute treatment. Prophylactic treatment is needed in case of attacks that are frequent and/or difficult to treat. The first drugs of choice as preventatives of tension type headache are tricyclic antidepressants, with a special focus on amitriptyline, the efficacy of which having been documented in multiple double-blind, placebo-controlled studies. Among other antidepressants, the efficacy of mirtazapine and venlafaxine has been documented. There is weaker evidence about the efficacy of gabapentine, topiramate, and tizanidin. Non-pharmacological prophylactic methods of tension type headache with a documented efficacy include certain types of psychotherapy and acupuncture.
Topics: Amitriptyline; Antidepressive Agents, Tricyclic; Humans; Tension-Type Headache
PubMed: 30785242
DOI: 10.18071/isz.72.0013 -
JAMA May 2021Approximately 90% of people in the US experience headache during their lifetime. Migraine is the second leading cause of years lived with disability worldwide. (Review)
Review
IMPORTANCE
Approximately 90% of people in the US experience headache during their lifetime. Migraine is the second leading cause of years lived with disability worldwide.
OBSERVATIONS
Primary headache disorders are defined as headaches that are unrelated to an underlying medical condition and are categorized into 4 groups: migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary headache disorders. Studies evaluating prevalence in more than 100 000 people reported that tension-type headache affected 38% of the population, while migraine affected 12% and was the most disabling. Secondary headache disorders are defined as headaches due to an underlying medical condition and are classified according to whether they are due to vascular, neoplastic, infectious, or intracranial pressure/volume causes. Patients presenting with headache should be evaluated to determine whether their headache is most likely a primary or a secondary headache disorder. They should be evaluated for symptoms or signs that suggest an urgent medical problem such as an abrupt onset, neurologic signs, age 50 years and older, presence of cancer or immunosuppression, and provocation by physical activities or postural changes. Acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine. Patients not responsive to these treatments may require migraine-specific treatments including triptans (5-HT1B/D agonists), which eliminate pain in 20% to 30% of patients by 2 hours, but are accompanied by adverse effects such as transient flushing, tightness, or tingling in the upper body in 25% of patients. Patients with or at high risk for cardiovascular disease should avoid triptans because of vasoconstrictive properties. Acute treatments with gepants, antagonists to receptors for the inflammatory neuropeptide calcitonin gene-related peptide, such as rimegepant or ubrogepant, can eliminate headache symptoms for 2 hours in 20% of patients but have adverse effects of nausea and dry mouth in 1% to 4% of patients. A 5-HT1F agonist, lasmiditan, is also available for acute migraine treatment and appears safe in patients with cardiovascular risk factors. Preventive treatments include antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, which reduce migraine by 1 to 3 days per month relative to placebo.
CONCLUSIONS AND RELEVANCE
Headache disorders affect approximately 90% of people during their lifetime. Among primary headache disorders, migraine is most debilitating and can be treated acutely with analgesics, nonsteroidal anti-inflammatory drugs, triptans, gepants, and lasmiditan.
Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Calcitonin Gene-Related Peptide Receptor Antagonists; Diagnosis, Differential; Headache Disorders; Humans; Migraine Disorders; Tension-Type Headache; Tryptamines
PubMed: 33974014
DOI: 10.1001/jama.2021.1640 -
The Journal of Headache and Pain Sep 2018A myofascial trigger point is defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. It has been... (Review)
Review
BACKGROUND
A myofascial trigger point is defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. It has been suggested that myofascial trigger points take part in chronic pain conditions including primary headache disorders. The aim of this narrative review is to present an overview of the current imaging modalities used for the detection of myofascial trigger points and to review studies of myofascial trigger points in migraine and tension-type headache.
FINDINGS
Different modalities have been used to assess myofascial trigger points including ultrasound, microdialysis, electromyography, infrared thermography, and magnetic resonance imaging. Ultrasound is the most promising of these modalities and may be used to identify MTrPs if specific methods are used, but there is no precise description of a gold standard using these techniques, and they have yet to be evaluated in headache patients. Active myofascial trigger points are prevalent in migraine patients. Manual palpation can trigger migraine attacks. All intervention studies aiming at trigger points are positive, but this needs to be further verified in placebo-controlled environments. These findings may imply a causal bottom-up association, but studies of migraine patients with comorbid fibromyalgia syndrome suggest otherwise. Whether myofascial trigger points contribute to an increased migraine burden in terms of frequency and intensity is unclear. Active myofascial trigger points are prevalent in tension-type headache coherent with the hypothesis that peripheral mechanisms are involved in the pathophysiology of this headache disorder. Active myofascial trigger points in pericranial muscles in tension-type headache patients are correlated with generalized lower pain pressure thresholds indicating they may contribute to a central sensitization. However, the number of active myofascial trigger points is higher in adults compared with adolescents regardless of no significant association with headache parameters. This suggests myofascial trigger points are accumulated over time as a consequence of TTH rather than contributing to the pathophysiology.
CONCLUSIONS
Myofascial trigger points are prevalent in both migraine and tension-type headache, but the role they play in the pathophysiology of each disorder and to which degree is unclarified. In the future, ultrasound elastography may be an acceptable diagnostic test.
Topics: Adolescent; Adult; Chronic Disease; Electromyography; Female; Humans; Male; Migraine Disorders; Muscle, Skeletal; Myofascial Pain Syndromes; Pain; Pain Measurement; Pressure; Tension-Type Headache; Trigger Points
PubMed: 30203398
DOI: 10.1186/s10194-018-0913-8 -
Dental Clinics of North America Oct 2018The primary headaches are composed of multiple entities that cause episodic and chronic head pain in the absence of an underlying pathologic process, disease, or... (Review)
Review
The primary headaches are composed of multiple entities that cause episodic and chronic head pain in the absence of an underlying pathologic process, disease, or traumatic injury. The most common of these are migraine, tension-type headache, and the trigeminal autonomic cephalalgias. This article reviews the clinical presentation, pathophysiology, and treatment of each to help in differential diagnosis. These headache types share many common signs and symptoms, thus a clear understanding of each helps prevent a delay in diagnosis and inappropriate or ineffective treatment. Many of these patients seek dental care because orofacial pain is a common presenting symptom.
Topics: Cluster Headache; Headache; Humans; Migraine Disorders; Paroxysmal Hemicrania; Tension-Type Headache; Trigeminal Autonomic Cephalalgias
PubMed: 30189986
DOI: 10.1016/j.cden.2018.06.006 -
Current Rheumatology Reviews 2016Tension type headache (TTH) is the most common headache and it has been discussed for years without reaching consensus on its pathophysiology, or proper rationale... (Review)
Review
Tension type headache (TTH) is the most common headache and it has been discussed for years without reaching consensus on its pathophysiology, or proper rationale management. This primary headache remains a challenge into its management for clinicians. This review aims to provide an updated and critical discussion on what is currently known and supported by scientific evidence about TTH and which gaps there still may be in our understanding of this condition. Clinical features of TTH resemble common manifestations of muscle referred pain. Episodic TTH may evolve into the chronic form by different aspects and several triggers may be involved at the same time. Both peripheral and central sensitization mechanisms seem to be clearly involved in this process. Individuals with episodic TTH exhibit higher levels of peripheral excitability whereas chronic TTH clearly show central sensitization manifestations. The role of associated muscle hyperalgesia seems to be important factors in TTH. Therapeutic management of individuals with TTH should be multimodal including appropriate use of pharmacological and non-pharmacological interventions to reduce the nociceptive peripheral drive to the central nervous system. If properly applied, treatment may not only reduce the number of TTH attacks but may also prevent or delay the transition from episodic to chronic TTH. Scientific evidence of pharmacological and nonpharmacological treatment is discussed in this review.
Topics: Humans; Tension-Type Headache
PubMed: 26717946
DOI: 10.2174/1573397112666151231113625 -
The Journal of Headache and Pain Jul 2023Tension-type headache (TTH) and migraine are two common primary headaches distinguished by clinical characteristics according to the 3 edition of the International... (Review)
Review
Tension-type headache (TTH) and migraine are two common primary headaches distinguished by clinical characteristics according to the 3 edition of the International Classification of Headache Disorders. Migraine is identified by specific features such as being more prevalent in females, being aggravated by physical activity, certain genetic factors, having photophobia, phonophobia, nausea, vomiting, or aura, and responding to specific drugs. Nonetheless, TTH and migraine share some common characteristics, such as onset occurring in the 20 s, and being triggered by psychological factors like stress, moderate pain severity, and mild nausea in chronic TTH. Both conditions involve the trigeminovascular system in their pathophysiology. However, distinguishing between TTH and migraine in clinical practice, research, and epidemiological studies can be challenging, as there is a lack of specific diagnostic tests and biomarkers. Moreover, both conditions may coexist, further complicating the diagnostic process. This review aims to explore the similarities and differences in the pathophysiology, epidemiology, burden and disability, comorbidities, and responses to pharmacological and non-pharmacological treatments of TTH and migraine. The review also discusses future research directions to address the diagnostic challenges and improve the understanding and management of these conditions.
Topics: Female; Humans; Tension-Type Headache; Migraine Disorders; Headache; Headache Disorders; Nausea
PubMed: 37474899
DOI: 10.1186/s10194-023-01614-0 -
The Lancet. Neurology Nov 2018Through the Global Burden of Diseases, Injuries, and Risk Factors (GBD) studies, headache has emerged as a major global public health concern. We aimed to use data from...
BACKGROUND
Through the Global Burden of Diseases, Injuries, and Risk Factors (GBD) studies, headache has emerged as a major global public health concern. We aimed to use data from the GBD 2016 study to provide new estimates for prevalence and years of life lived with disability (YLDs) for migraine and tension-type headache and to present the methods and results in an accessible way for clinicians and researchers of headache disorders.
METHODS
Data were derived from population-based cross-sectional surveys on migraine and tension-type headache. Prevalence for each sex and 5-year age group interval (ie, age 5 years to ≥95 years) at different time points from 1990 and 2016 in all countries and GBD regions were estimated using a Bayesian meta-regression model. Disease burden measured in YLDs was calculated from prevalence and average time spent with headache multiplied by disability weights (a measure of the relative severity of the disabling consequence of a disease). The burden stemming from medication overuse headache, which was included in earlier iterations of GBD as a separate cause, was subsumed as a sequela of either migraine or tension-type headache. Because no deaths were assigned to headaches as the underlying cause, YLDs equate to disability-adjusted life-years (DALYs). We also analysed results on the basis of the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility.
FINDINGS
Almost three billion individuals were estimated to have a migraine or tension-type headache in 2016: 1·89 billion (95% uncertainty interval [UI] 1·71-2·10) with tension-type headache and 1·04 billion (95% UI 1·00-1·09) with migraine. However, because migraine had a much higher disability weight than tension-type headache, migraine caused 45·1 million (95% UI 29·0-62·8) and tension-type headache only 7·2 million (95% UI 4·6-10·5) YLDs globally in 2016. The headaches were most burdensome in women between ages 15 and 49 years, with migraine causing 20·3 million (95% UI 12·9-28·5) and tension-type headache 2·9 million (95% UI 1·8-4·2) YLDs in 2016, which was 11·2% of all YLDs in this age group and sex. Age-standardised DALYs for each headache type showed a small increase as SDI increased.
INTERPRETATION
Although current estimates are based on limited data, our study shows that headache disorders, and migraine in particular, are important causes of disability worldwide, and deserve greater attention in health policy debates and research resource allocation. Future iterations of this study, based on sources from additional countries and with less methodological heterogeneity, should help to provide stronger evidence of the need for action.
FUNDING
Bill & Melinda Gates Foundation.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Bayes Theorem; Child; Child, Preschool; Community Health Planning; Cross-Sectional Studies; Disabled Persons; Female; Global Burden of Disease; Global Health; Humans; Male; Middle Aged; Migraine Disorders; Prevalence; PubMed; Retrospective Studies; Tension-Type Headache; Young Adult
PubMed: 30353868
DOI: 10.1016/S1474-4422(18)30322-3