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Expert Review of Neurotherapeutics Mar 2022Primary headache disorders, such as migraine and tension-type headache (TTH), represent a significant public health concern. Besides, cognitive/mental stress was...
INTRODUCTION
Primary headache disorders, such as migraine and tension-type headache (TTH), represent a significant public health concern. Besides, cognitive/mental stress was suggested to contribute to TTH and migraine physiopathology. Thus, this study aimed to evaluate the existence of a causal relationship between stress (mental/cognitive or daily stress) and headache or pain improvement in migraine and TTH patients.
AREAS COVERED
We developed a systematic review of the literature, including studies that utilized mental/cognitive stress tasks or daily stress by lifestyle questionnaire in migraine and TTH patients. Necessarily, these studies should have healthy patients and a pain measure (quantitative sensory tests or headache/migraine detection). PubMed, EMBASE, and SCOPUS were searched, using terms about stress and primary headaches.
EXPERT OPINION
Both mental/cognitive stress and daily stress (perceived) were related to an increase in pain perception and related to the development of headache or enhanced transient pain intensity in migraine and TTH patients. Different factors could enrich the comprehension of the influence of stress on pain/headache induction in migraine and TTH patients, including methodological standardization, consistency of assessing, and isolating the many headache triggers in randomized controlled trial studies.
Topics: Cognition; Headache; Humans; Migraine Disorders; Pain; Tension-Type Headache
PubMed: 35143379
DOI: 10.1080/14737175.2022.2041414 -
Headache Apr 2022To determine the efficacy of psychological interventions in studies of adults with migraine, in reducing pain, and functional and psychosocial difficulties. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the efficacy of psychological interventions in studies of adults with migraine, in reducing pain, and functional and psychosocial difficulties.
BACKGROUND
A recently published Cochrane Review showed no strong evidence for psychological intervention for adults with migraine. However, this review was limited by stringent inclusion criteria, potentially resulting in low power. The current review examines the stability of these findings.
METHODS
CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL databases were systematically searched from inception to July 31, 2021. Reviewers independently conducted the search and extraction process. Risk of bias was conducted, and we provide GRADE ratings of our confidence in the evidence. We included 39 randomized controlled trials in the meta-analyses (n = 3155); 31 included data on migraine only and eight combined data from adults with migraine or tension-type headache (TTH).
RESULTS
In contrast to the Cochrane Review, for studies including adults with migraine only, we found psychological interventions had a small to medium beneficial effect on improving migraine frequency, pain intensity, and disability post-treatment, compared to controls (Cohen's d range 0.23 to 0.33), and disability at follow-up (d = 0.44). We found no evidence of a beneficial effect on quality-of-life post-treatment, or mood at post-treatment or follow-up. Our sensitivity analyses on studies with mixed headache populations (migraine and combined migraine/TTH) found a similar magnitude of effects for most outcomes (d range 0.25 to 0.36), except for mood, which produced a small to medium beneficial effect (d = 0.32).
CONCLUSION
We found evidence that adults with migraine may benefit from psychological intervention, and psychological treatment may equally benefit adults with a range of headache conditions. However, as with previous reviews, quality of the evidence was low, findings should be cautiously interpreted, and this field would benefit from future high-quality trials.
Topics: Adult; Headache; Humans; Migraine Disorders; Pain Measurement; Psychosocial Intervention; Tension-Type Headache
PubMed: 35122436
DOI: 10.1111/head.14260 -
Frontiers in Medicine 2021To compare the efficacy of intravenous (IV) lidocaine with standard analgesics (NSAIDS, opioids) for pain control due to any cause in the emergency department.
OBJECTIVE
To compare the efficacy of intravenous (IV) lidocaine with standard analgesics (NSAIDS, opioids) for pain control due to any cause in the emergency department.
METHODS
The electronic databases of PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar were explored from 1st January 2000 to 30th March 2021 and randomized controlled trials (RCTs) comparing IV lidocaine with a control group of standard analgesics were included.
RESULTS
Twelve RCTs including 1,351 patients were included. The cause of pain included abdominal pain, renal or biliary colic, traumatic pain, radicular low back pain, critical limb ischemia, migraine, tension-type headache, and pain of unknown origin. On pooled analysis, we found no statistically significant difference in pain scores between IV lidocaine and control group at 15 min (MD: -0.24 95% CI: -1.08, 0.61 = 81% = 0.59), 30 min (MD: -0.24 95% CI: -1.03, 0.55 = 86% = 0.55), 45 min (MD: 0.31 95% CI: -0.66, 1.29 = 66% = 0.53), and 60 min (MD: 0.59 95% CI: -0.26, 1.44 = 75% = 0.18). There was no statistically significant difference in the need for rescue analgesics between the two groups (OR: 1.45 95% CI: 0.82, 2.56 = 41% = 0.20), but on subgroup analysis, the need for rescue analgesics was significantly higher with IV lidocaine in studies on abdominal pain but not for musculoskeletal pain. On meta-analysis, there was no statistically significant difference in the incidence of side-effects between the two study groups (OR: 1.09 95% CI: 0.59, 2.02 = 48% = 0.78).
CONCLUSION
IV lidocaine can be considered as an alternative analgesic for pain control in the ED. However, its efficacy may not be higher than standard analgesics. Further RCTs with a large sample size are needed to corroborate the current conclusions.
PubMed: 35111766
DOI: 10.3389/fmed.2021.706844 -
Atencion Primaria Mar 2022The objective of this work was to systematically review the published literature in relation to the estimated indirect costs associated with TTH.
OBJECTIVE
The objective of this work was to systematically review the published literature in relation to the estimated indirect costs associated with TTH.
DESIGN
This systematic review followed the Preferred Reporting Items Statement for Systematic Reviews and Meta-analyzes (PRISMA).
DATA SOURCES
The review was performed in two main databases, PubMed and EconLit, and was completed with the gray literature search.
STUDY SELECTION
The basic criterion for the inclusion of studies was that they present at least one measure of indirect costs specific to TTH.
DATA EXTRACTION
12 studies were finally selected for information extraction. Of all the selected articles, the characteristics of the study design, the types of costs included, as well as the measurement instrument, and the main results were synthesized.
RESULTS
The search yielded a total of 568 studies. Heterogeneity was found in the designs and samples/populations of the included studies. Only two studies estimated direct and indirect costs for TTH. Among the most notable results, we find an estimated moderate impact of disability due to TTH (between 0.037 and 0.15 per person, 0.06-0.09% for the population). Productivity and efficiency losses were observed and were very heterogeneous. The willingness to pay for effective treatment would range from $1.32 to $9.20 per month. Quality of life is low, between 28.2 and 28.4 points out of 100, and health-related quality of life seems to improve significantly with treatment.
CONCLUSIONS
Despite the high heterogeneity of the results, we can conclude that tension headache is characterized by a moderate impact on disability, on productivity and efficiency at work or school, and on the quality of life of those who suffer it.
Topics: Humans; Quality of Life; Tension-Type Headache; Treatment Outcome
PubMed: 35077913
DOI: 10.1016/j.aprim.2021.102238 -
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 -
Pain Physician Dec 2021Increased pericranial tenderness is considered to be a typical characteristic of tension-type headache (TTH). Assessment of pericranial tenderness in TTH using the total... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Increased pericranial tenderness is considered to be a typical characteristic of tension-type headache (TTH). Assessment of pericranial tenderness in TTH using the total tenderness score is recommended by the International Classification of Headache Disorders-3 (ICHD-3). However, to what extent pericranial tenderness differs between patients with TTH or migraine and healthy patients is unknown.
OBJECTIVE
To assess the presence and differences in total tenderness score between patients with TTH or migraine, and healthy patients.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
A literature search was performed in Pubmed/MEDLINE, EMBASE, CINAHL, and Google Scholar databases from inception to August 14, 2020 and identified 4,197 hits. Two independent reviewers selected the studies, extracted data, and performed a risk of bias assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From the 185 papers identified, 15 case-control and 2 cross-sectional studies were included.
RESULTS
In total 1,200 (327 men, 873 women) patients with TTH or migraine were included in the systematic review. In the meta-analysis, 15 studies were analyzed and showed that the total tenderness score is higher in people with episodic TTH (standardized mean difference [SMD] 0.91; 95% confidence interval [CI]: 0.63 to 1.19), chronic TTH (SMD 1.57; 95% CI 1.24 to 1.91) and migraine (SMD 1.27; 95% CI: 0.91to 1.63) compared to healthy patients.
LIMITATIONS
The description and performance of the total tenderness score differed across the studies. In 7 studies, patients were included with coexisting types of headache.
CONCLUSION
We found moderate quality evidence for higher tenderness in chronic TTH and migraine, and low quality evidence for higher tenderness in episodic TTH compared to healthy patients. Pericranial tenderness is a common finding in patients with headache and healthy patients. These findings apply for a critical evaluation of the total tenderness score in the current ICHD-3 classification of TTH.
Topics: Case-Control Studies; Cross-Sectional Studies; Female; Headache Disorders; Humans; Male; Migraine Disorders; Tension-Type Headache
PubMed: 34793636
DOI: No ID Found -
Pain Physician Nov 2021Headache is a very common condition that affects 5-9% of men and 12-25% of women in North America and Europe. Globally, the prevalence of active headaches among adults...
BACKGROUND
Headache is a very common condition that affects 5-9% of men and 12-25% of women in North America and Europe. Globally, the prevalence of active headaches among adults is 47%. The most common type of headache is tension headaches (38% of adults), followed by migraines (10%), and chronic headaches (3%). While the majority of headaches are benign, the disorder can severely negatively influence a patients' quality of life, which is directly reflected in societal costs.
OBJECTIVE
The objective of this review was to summarize available evidence behind radiofrequency ablation (RFA) for headache, including pain outcome measures, secondary outcomes, and complications.
STUDY DESIGN
Systematic review.
SETTING
This systematic review examined studies that applied the use of RFA for management of headache.
METHODS
This systematic review was reported following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Two reviewers independently scored the methodological quality of the selected studies. Due to heterogeneity of studies, a best-evidence synthesis of the available prognostic factors was provided.
RESULTS
In the present investigation, we evaluated 18 studies composed of 6 randomized controlled trials (RCTs), 6 prospective studies, and 6 retrospective studies. All the studies assessed pain improvement with RFA in patients with headache. Most studies targeted the occipital nerve for treatment. Complications were mostly mild and self-limiting, including eyelid swelling, rash, superficial infection of the procedural site, and worsening of headache.
LIMITATIONS
A large variability in definitions of trigeminal neuralgia, radiofrequency technique, and patient selection bias was observed in our selected cohort of studies. In addition, there is a paucity of strong longitudinal RCTs and prospective studies.
CONCLUSION
Our review discusses several studies that suggest the efficacy of RFA in the treatment of headaches. Outcomes varied based on the difference in approaches regarding continuous radiofrequency versus pulsed radiofrequency, temperature, and duration of administration. The majority of the studies discussed in this review indicate a therapeutic benefit of RFA for headaches over a short-term period. Pain outcomes beyond one year are understudied and further studies are needed to determine the long-term effects of RFA for headaches.
Topics: Adult; Catheter Ablation; Female; Headache; Humans; Male; Prospective Studies; Radiofrequency Ablation; Trigeminal Neuralgia
PubMed: 34704708
DOI: No ID Found -
Journal of the American Dental... Feb 2022The primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults?
TYPES OF STUDIES REVIEWED
The protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 6 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation.
RESULTS
Nine of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 7 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 1.94 [95% CI, 0.56 to 6.76] to OR, 7.61 [95% CI, 1.84 to 31.48]), migraines (OR, 4.14 [95% CI, 1.38 to 12.43] to OR, 5.44 [95% CI, 3.61 to 8.21]), and chronic headaches (OR, 40.40 [95% CI, 8.67 to 188.15] to OR, 95.93 [95% CI, 12.53 to 734.27]) were calculated. Articular TMDs without pain were evaluated in 2 articles, and both did not show positive association with tension-type headache nor migraine. Three studies were classified as moderate risk of bias and 6 as low risk of bias. The certainty of evidence varied between very low and low.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Recognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist.
Topics: Adult; Facial Pain; Headache; Humans; Migraine Disorders; Temporomandibular Joint Disorders; Tension-Type Headache
PubMed: 34649707
DOI: 10.1016/j.adaj.2021.07.021 -
Cureus Aug 2021Tension-type headache is one of the most prevalent types of headache. The common presentation is a mild-to-moderate dull aching pain around the temporal region, like a... (Review)
Review
Tension-type headache is one of the most prevalent types of headache. The common presentation is a mild-to-moderate dull aching pain around the temporal region, like a tight band around the forehead, neck, shoulder, and sometimes behind eyes. It can occur at any age but most commonly in the adult female population. The exact underlying mechanism is not clear but muscle tension is one of the main causes, which can be due to stress and anxiety. There are several non-pharmacologic treatment options suggested for tension-type headaches, such as cognitive behavioral therapy, relaxation, biofeedback, acupuncture, exercise, manual therapy, and even some home remedies. This systematic review was performed to evaluate the effectiveness of acupuncture and manual therapy in tension-type headaches. The literature search was primarily done on PubMed. Eight articles involving 3846 participants showed evidence that acupuncture and manual therapy can be valuable non-pharmacological treatment options for tension-type headaches. Acupuncture was compared to routine care or sham intervention. Acupuncture was not found to be superior to physiotherapy, exercise, and massage therapy. Randomized controlled trials done in various countries showed manual therapy also significantly decreased headache intensity. Manual therapy has an efficacy that equals prophylactic medication and tricyclic antidepressants in treating tension-type headaches. The available data suggests that both acupuncture and manual therapy have beneficial effects on treating symptoms of tension-type headache. However, further clinical trials looking at long-term benefits and risks are needed.
PubMed: 34646653
DOI: 10.7759/cureus.17601 -
The Journal of Headache and Pain Oct 2021
Correction to: 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.
PubMed: 34615456
DOI: 10.1186/s10194-021-01329-0