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Canadian Family Physician Medecin de... Aug 2015To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. (Review)
Review
OBJECTIVE
To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care.
QUALITY OF EVIDENCE
A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process.
MAIN MESSAGE
A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache.
CONCLUSION
A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache.
Topics: Adult; Cluster Headache; Headache; Headache Disorders, Primary; Humans; Migraine Disorders; Practice Guidelines as Topic; Primary Health Care; Tension-Type Headache
PubMed: 26273080
DOI: No ID Found -
Nature Reviews. Disease Primers Mar 2021
Topics: Humans; Tension-Type Headache
PubMed: 33767173
DOI: 10.1038/s41572-021-00263-4 -
Disability and Rehabilitation May 2022To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type... (Meta-Analysis)
Meta-Analysis
PURPOSE
To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type headache (TTH).
METHODS
Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized controlled trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis.
RESULTS
Fifteen studies were included with a total sample of 1131 individuals. High velocity and low amplitude techniques were not superior to no treatment on reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = -0.27, moderate evidence). Soft tissue interventions were superior to no treatment on reducing pain intensity (SMD = -0.86, low evidence) and frequency of pain (SMD = -1.45, low evidence). Dry needling was superior to no treatment on reducing pain intensity (SMD = -5.16, moderate evidence) and frequency (SMD = -2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache.
CONCLUSION
Manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache.Implications for rehabilitationSoft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache.High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache.Manual therapy was not effective for improving the impact of headache in patients with tension type headache.
Topics: Dry Needling; Headache; Humans; Musculoskeletal Manipulations; Pain; Tension-Type Headache
PubMed: 32924640
DOI: 10.1080/09638288.2020.1813817 -
FP Essentials Oct 2018Tension-type headache (TTH) is the most common primary headache disorder, with a worldwide lifetime prevalence of 46% to 78%. TTH causes greater disability and accounts... (Review)
Review
Tension-type headache (TTH) is the most common primary headache disorder, with a worldwide lifetime prevalence of 46% to 78%. TTH causes greater disability and accounts for more missed work days than migraine. The etiology of TTH is thought to be multifactorial, involving genetic and environmental factors. The three subtypes of TTH are infrequent episodic, frequent episodic, and chronic. Patients typically describe headache pain as pressing, dull, and with the sensation of a tight band around the head. Nonprescription analgesics are indicated for management of episodic TTH. Prophylaxis should be considered for patients with chronic TTH, with very frequent episodic TTH, at risk of medication overuse headache, and who are unable to tolerate effective doses of first-line drugs. Amitriptyline is recommended as a first-line drug for prophylaxis. (This is an off-label use of amitriptyline.) Physical and integrative therapies for TTH management include electromyography biofeedback, cognitive behavioral therapy, exercise, massage, and trigger point injection.
Topics: Amitriptyline; Analgesics, Non-Narcotic; Biofeedback, Psychology; Cognitive Behavioral Therapy; Diagnosis, Differential; Disability Evaluation; Electromyography; Exercise Therapy; Family Practice; Humans; Injections; Integrative Medicine; Massage; Tension-Type Headache; Trigger Points
PubMed: 30346680
DOI: No ID Found -
The Journal of Headache and Pain Aug 2021Tension-type headache (TTH) has been ranked the second most prevalent health condition worldwide. Non-pharmacological treatments for TTH are widely used as a supplement... (Meta-Analysis)
Meta-Analysis Review
Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education for patients with tension-type headache. A systematic review and meta-analysis.
BACKGROUND
Tension-type headache (TTH) has been ranked the second most prevalent health condition worldwide. Non-pharmacological treatments for TTH are widely used as a supplement or an alternative to medical treatment. However, the evidence for their effects are limited. Therefore, the aim of this study was to review the evidence for manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education as treatments for TTH on the effect of headache frequency and quality of life.
METHODS
A systematic literature search was conducted from February to July 2020 for clinical guidelines, systematic reviews, and individual randomised controlled trials (RCT). The primary outcomes measured were days with headache and quality of life at the end of treatment along with a number of secondary outcomes. Meta-analyses were performed on eligible RCTs and pooled estimates of effects were calculated using the random-effect model. The overall certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). In addition, patient preferences were included in the evaluation.
RESULTS
In all, 13 RCTs were included. Acupuncture might have positive effects on both primary outcomes. Supervised physical activity might have a positive effect on pain intensity at the end of treatment and headache frequency at follow-up. Manual joint mobilisation techniques might have a positive effect on headache frequency and quality of life at follow-up. Psychological treatment might have a positive effect on stress symptoms at the end of treatment. No relevant RCTs were identified for patient education. The overall certainty of evidence was downgraded to low and very low. No serious adverse events were reported. A consensus recommendation was made for patient education and weak recommendations for the other interventions.
CONCLUSION
Based on identified benefits, certainty of evidence, and patient preferences, manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture, and patient education can be considered as non-pharmacological treatment approaches for TTH. Some positive effects were shown on headache frequency, quality of life, pain intensity and stress symptoms. Few studies and low sample sizes posed a challenge in drawing solid conclusions. Therefore, high-quality RCTs are warranted.
Topics: Acupuncture Therapy; Exercise; Headache; Humans; Patient Education as Topic; Tension-Type Headache
PubMed: 34418953
DOI: 10.1186/s10194-021-01298-4 -
The Journal of the American Osteopathic... Oct 2019
Topics: Humans; Manipulation, Osteopathic; Pain Measurement; Tension-Type Headache
PubMed: 31566700
DOI: 10.7556/jaoa.2019.096 -
Neurology Oct 2022Whether acupuncture is effective for chronic tension-type headache (CTTH) is inconclusive. We aimed to examine the effectiveness of acupuncture with a follow-up period... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVES
Whether acupuncture is effective for chronic tension-type headache (CTTH) is inconclusive. We aimed to examine the effectiveness of acupuncture with a follow-up period of 32 weeks.
METHODS
We conducted a randomized controlled trial, and 218 participants who were diagnosed with CTTH were recruited from June 2017 to September 2020. The participants in the intervention group received 20 sessions of true acupuncture (TA) over 8 weeks. The acupuncture treatments were standardized across participants, and each acupuncture site was needled to achieve sensation. Each treatment session lasted 30 minutes. The participants in the control group received the same sessions and treatment frequency as those in the superficial acupuncture (SA) group-defined as a type of sham control by avoiding sensation at each acupuncture site. The main outcome was the responder rate at 16 weeks after randomization (week 16) and was followed up at week 32. A responder was defined as a participant who reported at least a 50% reduction in the monthly number of headache days (MHDs).
RESULTS
Our study included 218 participants (mean age: 43.1 years, mean disease duration: 130 months, MHDs: 21.5 days). The responder rate was 68.2% in the TA group (n = 110) vs 48.1% in the SA group (n = 108) at week 16 (OR, 2.65; 95% CI, 1.5 to 4.77; < 0.001); and it was 68.2% in the TA group vs 50% in the SA group at week 32 (OR, 2.4; 95%CI, 1.36 to 4.3; < 0.001). The reduction in MHDs was 13.1 ± 9.8 days in the TA group vs 8.8 ± 9.6 days in the SA group at week 16 (mean difference, 4.3 days; 95%CI, 2.0 to 6.5; < 0.001), and the reduction was 14 ± 10.5 days in the TA group vs 9.5 ± 9.3 days in the SA group at week 32 (mean difference, 4.5 days; 95%CI, 2.1 to 6.8; < 0.001). Four mild adverse events were reported; 3 in the TA group vs 1in the SA group.
DISCUSSION
The 8-week TA treatment was effective for the prophylaxis of CTTH. Further studies might focus on the cost-effectiveness of the treatment.
TRIAL REGISTRATION INFORMATION
ClinicalTrials.gov: NCT03133884 (clinicaltrials.gov/ct2/show/NCT03133884).
CLASSIFICATION OF EVIDENCE
This study provides Class I evidence that acupuncture (achieving deqi sensation) reduces the mean headache days (per month) in patients with CTTH.
Topics: Humans; Adult; Tension-Type Headache; Acupuncture Therapy; Time; Sensation; Headache; Treatment Outcome
PubMed: 35732505
DOI: 10.1212/WNL.0000000000200670 -
Current Pain and Headache Reports Nov 2023Stroke is a major health concern and a leading cause of long-term disability. Persistent post-stroke headache (PPSH) is a common complication of stroke yet little is... (Review)
Review
PURPOSE OF REVIEW
Stroke is a major health concern and a leading cause of long-term disability. Persistent post-stroke headache (PPSH) is a common complication of stroke yet little is known about its specific characteristics or optimal management. The purpose of this review is to discuss the epidemiology, presentation, and hypothesized pathophysiology of PPSH. Acute and preventive treatment options, as well as specific concerns regarding triptans and the newer CGRP antagonists, will be discussed in detail as well.
RECENT FINDINGS
The 2018 International Classification of Headache Disorders, 3rd edition (ICHD-3) was the first headache diagnostic manual to include criteria for PPSH and defines this disorder as an acute headache that develops in close temporal relation to stroke and persists beyond 3 months. Recent literature estimates the prevalence of PPSH to be somewhere between 1 and 23% of patients post-stroke. Presentation is variable, but most often mimics tension-type headache. There are no evidence-based guidelines on the optimal treatment of PPSH. PPSH is a common but poorly understood complication of stroke. Given the significant disability burden that PPSH carries, the epidemiology and pathophysiology of PPSH, as well as the efficacy and safety of potential treatment options, warrant further investigation.
Topics: Humans; Headache; Headache Disorders; Tension-Type Headache; Stroke; Prevalence
PubMed: 37676411
DOI: 10.1007/s11916-023-01169-4 -
JAAPA : Official Journal of the... Apr 2023
Topics: Humans; Tension-Type Headache; Migraine Disorders
PubMed: 36976033
DOI: 10.1097/01.JAA.0000921272.86882.2d -
Cephalalgia : An International Journal... Aug 2022This systematic review assesses the effectiveness of physiotherapy on headache parameters and quality of life of patients with tension-type headache using network... (Meta-Analysis)
Meta-Analysis
Effectiveness of physiotherapy interventions on headache intensity, frequency, duration and quality of life of patients with tension-type headache. A systematic review and network meta-analysis.
BACKGROUND
This systematic review assesses the effectiveness of physiotherapy on headache parameters and quality of life of patients with tension-type headache using network meta-analysis.
METHODS
A systematic search was conducted in the databases Web of Science, Medline, Cochrane Library and Physiotherapy Evidence Database up to August 2021. Randomised controlled trials investigating the effect of physiotherapy on tension-type headache were included. Risk of bias assessment was performed using the Risk of bias tool 2.0. Results were presented according to the Cochrane handbook and the PRISMA statement.
RESULTS
Twenty reports were eligible and 15 were included in network meta-analysis for pain intensity and frequency. Transcutaneous electrical stimulation combined with physiotherapy was the most effective approach to reduce pain intensity compared to control (mean difference (MD): -4.18, moderate confidence) and usual care (MD: -3.8, moderate confidence) Manual therapy (joint mobilisation) plus exercise was the most effective intervention to reduce headache frequency compared to control (MD: -13.03, low confidence) and usual care (MD: -13.95, moderate confidence).
CONCLUSION
Results suggest a combination of passive physiotherapy techniques with exercise and/or transcutaneous electrical stimulation as the most effective physiotherapy intervention to reduce pain intensity and frequency in the short term. More research is needed to investigate mid-term and long-term effects.: This review was prospectively registered in www.aspredicted.org under the registration number #46098 and an updated protocol was registered in the Open Science Framework (OSF) with the registration DOI: https://doi.org/10.17605/OSF.IO/RVUEY.
Topics: Headache; Humans; Network Meta-Analysis; Physical Therapy Modalities; Quality of Life; Tension-Type Headache
PubMed: 35236143
DOI: 10.1177/03331024221082073