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Current Neurology and Neuroscience... Oct 2021Description of headache dates back thousands of years, and to date, tension-type headache (TTH) remains the most common form of headache. We will review the history and... (Review)
Review
PURPOSE OF REVIEW
Description of headache dates back thousands of years, and to date, tension-type headache (TTH) remains the most common form of headache. We will review the history and current understanding of the pathophysiology of TTH and discuss the recommended clinical evaluation and management for this syndrome.
RECENT FINDINGS
Despite being the most prevalent headache disorder, TTH pathophysiology remains poorly understood. Patients with TTH tend to have muscles that are harder, more tender to palpation, and may have more frequent trigger points of tenderness than patients without headache. However, cause and effect of these muscular findings are unclear. Studies support both peripheral and central mechanisms contributing to the pain of TTH. Diagnosis is based on clinical presentation, while the focus of evaluation is to rule out possible secondary causes of headache. Treatment options have remained similar over the course of the past decade, with some additional studies supportive of both pharmacological and non-pharmacological options. An approach to TTH has been outlined including historical context, evolution over time, and the best evidence regarding our current understanding of the complex pathophysiology and treatment of this disease.
Topics: Humans; Pain; Tension-Type Headache
PubMed: 34599406
DOI: 10.1007/s11910-021-01138-7 -
The Journal of Pain Jul 2022The primary aim of this study was to review the effect of exercise in comparison with a non-active treatment on pain intensity, frequency of headache episodes, headache... (Meta-Analysis)
Meta-Analysis Review
The primary aim of this study was to review the effect of exercise in comparison with a non-active treatment on pain intensity, frequency of headache episodes, headache duration, quality of life, medication use, and psychological symptoms, in patients with migraine or tension-type headache (TTH). A systematic search was conducted in various electronic databases to identify all relevant studies: Medline (PubMed), PEDro, EBSCO and Google Scholar. Clinical trials assessing the effects of exercise interventions in patients with primary headaches were selected. Methodological quality was evaluated using the Cochrane Risk of Bias Tool and PEDro scale and qualitative analysis was based on classifying the results into levels of evidence according to the GRADE. 19 studies (2776 participants; 85% female) were included. The meta-analysis showed statistically significant differences in pain intensity for aerobic training in patients with migraine (SMD = -0.65; 95% CI = -1.07 to -0.22, very low certainty evidence) and for strength training in patients with TTH (SMD = -0.84; 95% CI = -1.68 to- -0.01, very low certainty evidence). Statistically significant differences were also found in the medication use (SMD = -0.51; 95% CI = -0.85 to -0.17, low certainty evidence). Low transparency, replicability and high risk of bias were found. Aerobic training has a small to moderate clinical effect on pain intensity and medication use on migraine patients, with very low to low certainty of evidence. Strength training showed a moderate clinical effect with very low quality of evidence in patients with TTH. Exercise could be considered as clinically relevant for the management of patients with primary headaches, but the presence of low certainty of evidence and low transparency and replicability limited its clinical application. PERSPECTIVE: This article presents current evidence about exercise interventions in patients with primary headaches, including migraine and tension-type headache. Existing findings are reviewed, and relevant data are provided on the effectiveness of each exercise modality, as well as its certainty of evidence and clinical applicability.
Topics: Exercise; Female; Headache; Humans; Male; Migraine Disorders; Quality of Life; Tension-Type Headache
PubMed: 34929374
DOI: 10.1016/j.jpain.2021.12.003 -
Neurologia May 2018Non-pharmacological treatments help control tension-type headache; however, evidence about their effectiveness is still limited. This study evaluates the effectiveness... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Non-pharmacological treatments help control tension-type headache; however, evidence about their effectiveness is still limited. This study evaluates the effectiveness of physical therapy based on cervical spine kinesiotherapy and posture correction exercises compared to a programme of relaxation techniques only (Schultz's Autogenic Training, AT).
METHODS
Tension-type headache is very common among university students. We randomly selected 152 university students with a diagnosis of tension-type headache according to the criteria of the International Headache Society. Eighty-four were women (55.3%) and 68 were men (44.7%). Mean age was 20.42±2.36 years. The study design is a randomised controlled trial of a non-pharmacological intervention with a blinded evaluation of response variables. We compared the results of two independent samples: AT was used in one of the groups while the other group received AT plus cervical spine kinesiotherapy and posture correction training. Patients recorded any changes in the parameters of pain (frequency, intensity, and duration) and drug consumption in a headache diary before treatment, at 4 weeks, and at 3 months.
RESULTS
Both interventions achieved a decrease in all the parameters of pain; however, decreases in frequency and intensity were more significant in the combined treatment group (P<0.01) (d=0.4).
CONCLUSIONS
Such active, non-invasive therapies as AT and cervical spine kinesiotherapy, and especially the combination of both, effectively reduce tension-type headache by preventing and managing the potential psychophysical causes of this disorder. Future research should aim to assess the long-term effects of these interventions.
Topics: Adult; Female; Humans; Male; Musculoskeletal Manipulations; Pain; Physical Therapy Modalities; Relaxation Therapy; Tension-Type Headache; Young Adult
PubMed: 27491303
DOI: 10.1016/j.nrl.2016.06.008 -
Complementary Therapies in Clinical... May 2021To evaluate the effects of two manual treatment methods on pain, disability, and pressure pain threshold (PPT) in tension-type headache (TTH) patients with and neck pain. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To evaluate the effects of two manual treatment methods on pain, disability, and pressure pain threshold (PPT) in tension-type headache (TTH) patients with and neck pain.
METHODS
Forty-five patients with TTH were randomly assigned to one of three groups and received eight sessions treatment: manipulation plus exercise (manipulation), suboccipital inhibition plus exercise (myofascial release), and exercise only (control). Headache frequency, pain severity (VAS-headache, VAS-neck pain) and headache and neck disability (HIT-6 and NDI, respectively) were measured at baseline, posttreatment, and at the third month follow-up. PPT was also evaluated on the temporalis muscle.
RESULTS
Manipulation group was statistically better than myofascial release group in terms of headache frequency, headache severity, and PPT scores. Also, manipulation group showed statistically significant improvements in all outcome criteria when compared control group.
CONCLUSIONS
Manipulation and exercise, in addition to pharmacologic treatment in TTH patients with cervical dysfunction appear to be a promising approach.
Topics: Humans; Manipulation, Osteopathic; Manipulation, Spinal; Massage; Neck Pain; Tension-Type Headache
PubMed: 33517104
DOI: 10.1016/j.ctcp.2021.101319 -
Anales Del Sistema Sanitario de Navarra Dec 2018Headache is a very common phenomenon with a high economic and psychosocial impact. Tension-type headache (TTH) is the most prevalent (40%), especially amongst adult... (Review)
Review
INTRODUCTION
Headache is a very common phenomenon with a high economic and psychosocial impact. Tension-type headache (TTH) is the most prevalent (40%), especially amongst adult western women. The aim was to evaluate the existing evidence on the effectiveness of physiotherapy techniques in treating TTH.
METHODS
Literature review of randomised clinical trials (RCT) and systematic reviews, published over the last five years, on the physiotherapy techniques most used in treating TTH: therapeutic exercise, suboccipital inhibition, cervical manip-ulation, massage, joint mobilisation and puncture.
RESULTS
Twenty-six articles (seven reviews) met the criteria for inclusion. The reviews found evidence of the effectiveness of therapeutic exercise on the intensity, frequency and duration of pain. Improvement was also achieved by manual therapy in a similar way to medicines (although with contradictory long-term results), by the combination of dry puncture and physiotherapy on the VAS score, and by the combination of mobilisation techniques with stretching and muscular massage, but not separately. Amongst other results, the RCT showed that massage achieved less pain and frequency, as well as better quality of life, perceived clinical sensation and range of movement; pain improved with suboccipital inhibition and aerobic exercises; and the range of movement with cervical manipulation, massage of soft tissues and mobilisation.
CONCLUSION
The published clinical evidence endorses physiotherapy as an effective treatment in managing patients with TTH, although additional studies with a better quality methodology are required.
Topics: Humans; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Systematic Reviews as Topic; Tension-Type Headache
PubMed: 30425380
DOI: 10.23938/ASSN.0379 -
The Journal of Headache and Pain Feb 2023Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce.
MATERIAL AND METHODS
We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8-18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted.
RESULTS
Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9-14%], 8% for migraine without aura (MwoA) [95%CI: 5-12%], 3% for migraine with aura (MwA) [95%CI:2-4%] and 17% for tension-type headache (TTH) [95% CI: 12-23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53-70%], with prevalence in females and males of 38% [95% CI: 16-66%] and 27% [95% CI: 11-53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking.
CONCLUSION
We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions.
Topics: Male; Adult; Female; Humans; Child; Adolescent; Cross-Sectional Studies; Headache; Tension-Type Headache; Migraine with Aura; Migraine without Aura; Prevalence
PubMed: 36782182
DOI: 10.1186/s10194-023-01541-0 -
Musculoskeletal Science & Practice Aug 2023The concept that headaches may originate in the cervical spine has been discussed over decades and is still a matter of debate. The cervical spine has been traditionally...
INTRODUCTION
The concept that headaches may originate in the cervical spine has been discussed over decades and is still a matter of debate. The cervical spine has been traditionally linked to cervicogenic headache; however, current evidence supports the presence of cervical musculoskeletal dysfunctions also in tension-type headache.
PURPOSE
This position paper discusses the most updated clinical and evidence-based data about the cervical spine in tension-type headache.
IMPLICATIONS
Subjects with tension-type headache exhibit concomitant neck pain, cervical spine sensitivity, forward head posture, limited cervical range of motion, positive flexion-rotation test and also cervical motor control disturbances. In addition, the referred pain elicited by manual examination of the upper cervical joints and muscle trigger points reproduces the pain pattern in tension-type headache. Current data supports that the cervical spine can be also involved in tension-type headache, and not just in cervicogenic headache. Several physical therapies including upper cervical spine mobilization or manipulation, soft tissue interventions (including dry needling) and exercises targeting the cervical spine are proposed for managing tension-type headache; however, the effectiveness of these interventions depends on a proper clinical reasoning since not all will be equally effective for all individuals with tension-type headache. Based on current evidence, we propose to use the terms cervical "component" and cervical "source" when discussing about headache. In such a scenario, in cervicogenic headache the neck can be the cause (source) of the headache whereas in tension-type headache the neck will have a component on the pain pattern, but it will be not the cause since it is a primary headache.
Topics: Humans; Tension-Type Headache; Post-Traumatic Headache; Headache; Physical Examination; Cervical Vertebrae
PubMed: 37268552
DOI: 10.1016/j.msksp.2023.102780 -
Neurologia 2022Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological... (Review)
Review
INTRODUCTION
Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache.
METHODS
We performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers.
RESULTS
Of a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes.
CONCLUSIONS
Dry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments.
Topics: Humans; Tension-Type Headache; Dry Needling; Headache; Post-Traumatic Headache; Migraine Disorders
PubMed: 35659858
DOI: 10.1016/j.nrleng.2019.09.010 -
Journal of General Internal Medicine Mar 2020Headache disorders are currently the sixth leading cause of disability across the globe and therefore carry a significant disease burden. This systematic review and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Headache disorders are currently the sixth leading cause of disability across the globe and therefore carry a significant disease burden. This systematic review and meta-analysis aims to investigate the effects of yoga on headache disorders.
METHODS
MEDLINE/PubMed, Scopus, the Cochrane Library, and PsycINFO were screened through May 2019. Randomized controlled trials (RCTs) were included when they assessed the effects of yoga in patients with a diagnosis of chronic or episodic headache (tension-type headache and/or migraine). Usual care (no specific treatment) or any active treatments were acceptable as control interventions. Primary outcome measures were headache frequency, headache duration, and pain intensity. For each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.
RESULTS
Meta-analysis revealed a statistically significant overall effect in favor of yoga for headache frequency (5 RCTs; standardized mean difference (SMD) = - 1.97; 95% confidence interval (CI) - 2.75 to - 1.20; I = 63.0%, τ = 0.25, P = 0.03), headache duration (4 RCTs; SMD = - 1.45; 95% CI - 2.54 to - 0.37; I = 69.0%, τ = 0.33, P = 0.02), and pain intensity (5 RCTs; SMD = - 3.43; 95% CI - 6.08 to - 0.70, I = 95.0%, τ = 4.25, P < 0.01). The significant overall effect was mainly due to patients with tension-type headaches. For patients with migraine, no statistically significant effect was observed.
DISCUSSION
Despite discussed limitations, this review found preliminary evidence of short-term efficacy of yoga in improving headache frequency, headache duration, and pain intensity in patients suffering from tension-type headaches. Further studies are urgently needed to draw deeper conclusions from the available results.
Topics: Disabled Persons; Headache; Humans; Migraine Disorders; Tension-Type Headache; Yoga
PubMed: 31667736
DOI: 10.1007/s11606-019-05413-9 -
Schmerz (Berlin, Germany) Jun 2016Tension-type headache is the most frequent form of headache. The local topical treatment with peppermint oil (oleum menthae piperitae) has proven to be significantly... (Review)
Review
Tension-type headache is the most frequent form of headache. The local topical treatment with peppermint oil (oleum menthae piperitae) has proven to be significantly more effective than placebo in controlled studies. Peppermint oil targets headache pathophysiology in multiple ways. The efficacy is comparable to that of acetylsalicylic acid or paracetamol. Solutions of 10 % peppermint oil in ethanol are licensed for the treatment of tension-type headache in adults and children above 6 years. It is included in treatment recommendations and guidelines by the respective professional societies and is regarded as a standard treatment for the acute therapy of tension-type headaches.
Topics: Acetaminophen; Administration, Cutaneous; Adult; Aspirin; Child; Controlled Clinical Trials as Topic; Guideline Adherence; Humans; Mentha piperita; Phytotherapy; Plant Oils; Tension-Type Headache; Treatment Outcome
PubMed: 27106030
DOI: 10.1007/s00482-016-0109-6