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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 -
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 -
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 -
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 -
Nature Reviews. Disease Primers Mar 2021
Topics: Humans; Tension-Type Headache
PubMed: 33767173
DOI: 10.1038/s41572-021-00263-4 -
Expert Review of Neurotherapeutics May 2008Tension-type headache (TTH) is the most prevalent of all headaches and also represents one of the most expensive clinical conditions for the health system. Despite the... (Review)
Review
Tension-type headache (TTH) is the most prevalent of all headaches and also represents one of the most expensive clinical conditions for the health system. Despite the high impact of this disorder and the existence of well-established diagnostic criteria, knowledge about TTH is still quite limited. In most cases in which crises are quite sporadic, the patients call this normal headache. However, there is a group of patients with the chronic subtype of this headache whose quality of life is greatly compromised. According to the second edition of the International Classification of Headache Disorders, TTH is a bilateral headache of the tight band of pressure type of mild-to-moderate intensity that does not worsen with routine physical activities and whose associated symptoms are less intense than those observed in migraine. Its physiopathology still awaits better elucidation but the existence of central and peripheral mechanisms is already recognized. From a therapeutic viewpoint, simple analgesics are used for the acute treatment of the condition, and tricyclic antidepressants are the most effective class of drugs for its prevention. Follow-up of these patients over the years has demonstrated that the course of TTH is quite favorable in most cases.
Topics: Analgesics; Antidepressive Agents; Clinical Trials as Topic; Humans; Tension-Type Headache; Treatment Outcome
PubMed: 18457540
DOI: 10.1586/14737175.8.5.839 -
Current Neurology and Neuroscience... Mar 2006Tension-type headache, the most common type of primary headache disorder, is reclassified in the second International Headache Society classification with clear... (Review)
Review
Tension-type headache, the most common type of primary headache disorder, is reclassified in the second International Headache Society classification with clear diagnostic criteria. Chronic tension-type headache (CTTH) differs from episodic form in frequency, lack of response to most treatment strategies, more medication overuse, and more loss of quality of life. New concepts in the pathophysiology of CTTH emphasize the possible role of central nociceptive pathway sensitization in addition to peripheral myogenic factors. Mechanisms of central sensitization, even though poorly understood, may involve nitric oxide system and N-methyl-D-aspartate receptors. Future treatment modalities are likely to be based on such mechanisms. Using MRI and voxel-based morphometry, structural abnormalities have been found in patients with CTTH for the first time. Pain processing areas such as dorsal rostral and ventral pons, anterior cingulate cortex, anterior and posterior insular cortex, right posterior temporal lobe, orbitofrontal cortex, para hippocampus bilaterally, and the right cerebellum were found to have decreased gray matter in patients with CTTH compared with control subjects and patients with medication overuse headache. Amitriptyline remains the most effective preventive treatment so far. The role of botulinum toxin is not fully defined.
Topics: Central Nervous System; Chronic Disease; Humans; Tension-Type Headache
PubMed: 16522262
DOI: 10.1007/s11910-996-0031-x -
Continuum (Minneapolis, Minn.) Aug 2012This article provides an update on the appropriate diagnosis and evaluation of patients with tension-type headache, with reviews of the latest concepts regarding... (Review)
Review
PURPOSE OF REVIEW
This article provides an update on the appropriate diagnosis and evaluation of patients with tension-type headache, with reviews of the latest concepts regarding pathogenesis and the evidence-based recommendations for management of this disorder.
RECENT FINDINGS
Pericranial myofascial mechanisms are probably of importance in episodic tension-type headache, whereas sensitization of central nociceptive pathways and inadequate endogenous antinociceptive circuitry seem to be more relevant in chronic tension-type headache. While acute treatment with simple analgesics is generally helpful, recent data attempting to document the efficacy of preventive therapies are unconvincing.
SUMMARY
Tension-type headache is the most common form of headache in the general population. It is characterized by recurrent episodes of headache that are relatively featureless and mild to moderate in intensity. The diagnosis is based solely on the history and examination. Exclusion of secondary headaches or forms of migraine is important in the assessment process. Despite extensive investigation, the underlying pathophysiology remains a matter of speculation, with peripheral muscular and CNS components both likely involved. Acute management with simple analgesics, nonsteroidal anti-inflammatory drugs, and caffeine-containing compounds is typically effective. Preventive therapies include a number of nonpharmacologic recommendations as well as several antidepressant drugs. Prognosis is generally favorable.
Topics: Adult; Central Nervous System; Female; Humans; Male; Middle Aged; Tension-Type Headache
PubMed: 22868544
DOI: 10.1212/01.CON.0000418645.32032.32 -
American Family Physician Sep 2002Tension-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... (Review)
Review
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.
Topics: Analgesics, Non-Narcotic; Chronic Disease; Humans; Medical History Taking; Physical Examination; Tension-Type Headache
PubMed: 12322770
DOI: No ID Found -
Current Pain and Headache Reports Dec 2009Tension-type headache is the most common headache type worldwide. Chronic tension-type headache (CTTH) affects 2% to 3% of patients, yet it represents the least talked... (Review)
Review
Tension-type headache is the most common headache type worldwide. Chronic tension-type headache (CTTH) affects 2% to 3% of patients, yet it represents the least talked about subtype of chronic daily headache. There is much debate in the headache community on whether CTTH exists as its own entity or is a milder form of chronic migraine (CM), because there are similarities and differences between the two headache forms. This article reviews CTTH, as well as the current pathophysiology and treatment, and discusses controversial issues in the diagnosis of CTTH and CM.
Topics: Chronic Disease; Clinical Trials as Topic; Humans; Migraine Disorders; Tension-Type Headache
PubMed: 19889291
DOI: 10.1007/s11916-009-0077-y