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The Journal of Pain Mar 2023Tension type headache (TTH) is a prevalent but poorly understood pain disease. Current understanding supports the presence of multiple associations underlying its...
Tension type headache (TTH) is a prevalent but poorly understood pain disease. Current understanding supports the presence of multiple associations underlying its pathogenesis. Our aim was to compare competing multivariate pathway models that explains the complexity of TTH. Headache features (intensity, frequency, or duration - headache diary), headache-related disability (Headache Disability Inventory-HDI), anxiety/depression (Hospital Anxiety and Depression Scale), sleep quality (Pittsburgh Sleep Quality Index), widespread pressure pain thresholds (PPTs) and trigger points (TrPs) were collected in 208 individuals with TTH. Four latent variables were formed from the observed variables - Distress (anxiety, depression), Disability (HDI subscales), Severity (headache features), and Sensitivity (all PPTs). Structural equation modelling (SEM) and Bayesian network (BN) analyses were used to build and compare a theoretical (model) and a data-driven (model) latent variable model. The model (root mean square error of approximation [RMSEA] = 0.035) provided a better statistical fit than model (RMSEA = 0.094). The only path common between model and model was the influence of years with pain on TrPs. The model revealed that the largest coefficient magnitudes were between the latent variables of Distress and Disability (β=1.524, P = .006). Our theoretical model proposes a relationship whereby psycho-physical and psychological factors result in clinical features of headache and ultimately affect disability. Our data-driven model proposes a more complex relationship where poor sleep, psychological factors, and the number of years with pain takes more relevance at influencing disability. Our data-driven model could be leveraged in clinical trials investigating treatment approaches in TTH. PERSPECTIVE: A theoretical model proposes a relationship where psycho-physical and psychological factors result in clinical manifestations of headache and ultimately affect disability. A data-driven model proposes a more complex relationship where poor sleep, psychological factors, and number of years with pain takes more relevance at influencing disability.
Topics: Humans; Tension-Type Headache; Bayes Theorem; Pain; Headache; Pain Threshold
PubMed: 36244659
DOI: 10.1016/j.jpain.2022.10.003 -
Revista Da Associacao Medica Brasileira... 2023The aim of this study was to compare the pressure pain threshold and the thickness of the cervical muscles in patients with tension-type headache versus healthy... (Observational Study)
Observational Study
OBJECTIVE
The aim of this study was to compare the pressure pain threshold and the thickness of the cervical muscles in patients with tension-type headache versus healthy participants.
METHODS
An observational, retrospective, cross-sectional study was conducted at the Universidad Europea de Madrid between May and June 2022. Adults aged 18-65 years with tension-type headache diagnosed for more than 6 months were compared to healthy controls. B-mode ultrasound imaging was employed to measure the thickness of the neck stabilizing muscles, longus colli, and multifidus at the C5 and C6 levels, respectively. pressure pain threshold measurements were assessed bilaterally in the following regions: upper trapezius, masseter, temporalis, anterior tibialis, and median nerve.
RESULTS
A total of 40 participants (90% females; 36.3±12.9 years, BMI 24.2±3.7 kg/m2) participated in the study. Compared with the control group (n=20), participants in the tension-type headache group (n=20) presented statistically significant lower values in all pressure pain threshold measures. Additionally, the tension-type headache group presented statistically significant lower values in the thickness of the following muscles: right multifidus at rest (1.0±0.2 cm versus 1.3±0.2 cm; p<0.001), left multifidus at rest (1.1±0.1 cm versus 1.3±0.1 cm; p<0.001) and during contraction (1.2±0.1 cm versus 1.5±0.2 cm; p<0.001), left longus colli at rest (1.0±0.2 cm versus 1.2±0.1 cm; p=0.01) and during contraction (1.2±0.2 cm versus 1.4±0.1 cm; p<0.001), and right longus colli during contraction (1.2±0.2 cm versus 1.4±0.2 cm; p=0.02).
CONCLUSION
This study concluded that patients with tension-type headache showed lower thickness and lower pressure pain threshold of cervical muscles compared to healthy controls.
Topics: Adult; Female; Humans; Male; Tension-Type Headache; Cross-Sectional Studies; Retrospective Studies; Pain; Neck Muscles; Atrophy
PubMed: 37729231
DOI: 10.1590/1806-9282.20230841 -
Headache Sep 2020To examine longitudinal associations between parent factors (parent headache frequency and disability, protective parenting behaviors, parent catastrophizing) with...
OBJECTIVE
To examine longitudinal associations between parent factors (parent headache frequency and disability, protective parenting behaviors, parent catastrophizing) with adolescent headache-related disability and headache frequency over 6 months.
BACKGROUND
Theoretical models propose bidirectional, longitudinal relationships between parent factors and adolescent headache. Few studies have examined this using prospective study designs.
DESIGN AND METHODS
Participants were a cohort of 239 youth ages 11-17 years with recurrent migraine (with and without aura; chronic migraine) or tension-type headache (episodic and chronic) and their parents recruited from a pediatric neurology clinic and the community who completed assessments at baseline and 6-month follow-up.
RESULTS
After controlling for demographic and clinical covariates, we found that every point increase in baseline protective parenting behavior corresponded with a 2.19-point increase in adolescent headache frequency at follow-up (P = .026, 95% CI [0.27, 4.10]). Similarly, every point increase in baseline parent catastrophizing corresponded with a 0.93-point increase in adolescent headache-related disability (P = .029, 95% CI [0.09, 1.77]) and a .13-point increase in adolescent headache frequency (P = .042, 95% CI [0.01, 0.25]) at follow-up. We also found support for the reverse association, where every point increase in baseline adolescent headache-related disability predicted a 0.03-point increase in parent catastrophizing (P = .016, 95% CI [0.01, 0.05]) and a 0.02-point increase in protective parenting behavior (P = .009, 95% CI [0.01, 0.03]) at follow-up. The remaining bidirectional, longitudinal associations tested between parent factors and adolescent headache were not statistically significant.
CONCLUSION
Findings suggest that family-based psychological interventions targeting modifiable adolescent and parent factors may lead to improvements in adolescent headache-related disability and reductions in adolescent headache frequency.
Topics: Adolescent; Catastrophization; Child; Child of Impaired Parents; Chronic Disease; Disabled Persons; Female; Humans; Longitudinal Studies; Male; Migraine Disorders; Parenting; Tension-Type Headache
PubMed: 32853406
DOI: 10.1111/head.13939 -
BMJ Open Nov 2023Tension-type headache (TTH) is the most prevalent headache disorder worldwide. Although current treatments for TTH are beneficial, they are not without adverse effects....
INTRODUCTION
Tension-type headache (TTH) is the most prevalent headache disorder worldwide. Although current treatments for TTH are beneficial, they are not without adverse effects. Chaixiong Qiwei granule (CXQW) is an experienced prescription medicine for TTH management. This study will evaluate the efficacy and safety of CXQW for the treatment of TTH.
METHODS AND ANALYSIS
This study will be a multicentre, randomised, double-blind, placebo-controlled trial. A total of 148 eligible participants will be divided into the intervention (CXQW treatment) and control (placebo treatment) groups. The primary outcome will be the reduction in the number of headache days (headache-days reduction) within 9-12 weeks after randomisation, while secondary outcomes will include the number of headache days, headache intensity, responder rate, drug consumption for acute treatment, quality of life and symptoms related to traditional Chinese medicine use based on a symptom-observation table. This protocol describes the design of the randomised controlled trial.
ETHICS AND DISSEMINATION
The study design was approved by the Institutional Review Board of Human Research at Xiyuan Hospital, China Academy of Chinese Medical Sciences (No. 2020XLA030-2).
TRIAL REGISTRATION NUMBER
ChiCTR2100042514.
Topics: Humans; Tension-Type Headache; Quality of Life; Double-Blind Method; Medicine, Chinese Traditional; Headache; Treatment Outcome; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 38035742
DOI: 10.1136/bmjopen-2023-074871 -
BMC Neurology Aug 2012To determine the differences of precipitating and relieving factors between migraine and tension type headache.
BACKGROUND
To determine the differences of precipitating and relieving factors between migraine and tension type headache.
METHODS
This is a cross sectional study. We retrospectively reviewed the records of 250 migraine patients and 250 patients diagnosed as tension type headache from the specialized headache clinic in Dept. of Neurology, Dhaka Medical College Hospital. Data were collected through a predesigned questionnaire containing information on age, sex, social status and a predetermined list of precipitating and relieving factors.
RESULTS
In this study, the female patients predominated (67%). Most of the patients were within 21-30 years age group (58.6%). About 58% of them belonged to middle class families. The common precipitating factors like stress, anxiety, activity, journey, reading, cold and warm were well distributed among both the migraine and tension type headache (TTH) patients. But significant difference was demonstrated for fatigue (p < 0.05), sleep deprivation (p < 0.05), sunlight (p < 0.01) and food (p < 0.05), which were common among migraineurs. In consideration of relieving factors of pain, different maneuvers were commonly tried by migraineurs and significant difference were observed for both analgesic drug and massage (p < 0.05), which relieved migraine headache. But maneuvers like sleep, rest and posture were used by both groups.
CONCLUSION
The most frequent precipitating factors for headache appear to be identical for both migraine and TTH patients. Even though some factors like fatigue, sleep deprivation, sunlight and food significantly precipitate migraine and drug, massage are effective maneuver for relieving pain among migrianeurs.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Bangladesh; Child; Child, Preschool; Comorbidity; Fatigue; Female; Humans; Incidence; Male; Massage; Middle Aged; Migraine Disorders; Risk Factors; Sex Distribution; Stress, Psychological; Tension-Type Headache; Young Adult
PubMed: 22920541
DOI: 10.1186/1471-2377-12-82 -
The Journal of Headache and Pain Feb 2011The main objective of this study is to investigate the relationship between tension-type headache and obstructive sleep apnea in the general population. The method...
The main objective of this study is to investigate the relationship between tension-type headache and obstructive sleep apnea in the general population. The method involves a cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. Included in this study were 297 persons with high risk and 134 persons with low risk of sleep apnea, aged 30-65 years. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Tension-type headache was diagnosed according to the International Classification of Headache Disorders. Results showed the prevalence of frequent and chronic tension-type headache was 18.7 and 2.1% in the participants with obstructive sleep apnea. The logistic regression analyses showed no significant relationship between tension-type headache and obstructive sleep apnea, with adjusted odds ratios for frequent tension-type headache of 0.95 (0.55-1.62) and chronic tension-type headache of 1.91 (0.37-9.85). The results did not change when using cut-off of moderate (AHI ≥15) and severe (AHI ≥30) obstructive sleep apnea. Thus, we did not find any significant relationship between tension-type headache and the AHI. The presence and severity of sleep apneas seem not to influence presence and attack-frequency of tension-type headache in the general population.
Topics: Adult; Aged; Cohort Studies; Comorbidity; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Neurologic Examination; Prevalence; Risk Assessment; Sleep Apnea, Obstructive; Tension-Type Headache
PubMed: 21161317
DOI: 10.1007/s10194-010-0265-5 -
Medicine Dec 2022Tension-type headache (TTH) refers to a type of functionalism disease, which is commonly characterized by recurrent headaches of mild to moderate intensity, bilateral...
INTRODUCTION
Tension-type headache (TTH) refers to a type of functionalism disease, which is commonly characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity. Has significantly impacts on people's work and life. Ear acupuncture as a traditional Chinese therapy, showing several advantages (e.g., safety, economy, and less side effects), has been extensively used to treat TTH. However, its curative effect is supported by limited evidence. Accordingly, the present study aims to comprehensively assess the reliability of ear acupuncture in TTH.
METHODS AND ANALYSIS
The study will conduct a systematic review and meta-analysis. Seven databases, including the Embase, Cochrane Library, Pubmed, SinoMed, CNKI, VIP, and Wanfang Data, will be searched using predefined search terms to identify relevant studies. The primary outcomes will be the pain intensity, the pain frequency and the impact of headache. The methodological quality of the included studies will be assessed with a previously established checklist. The Cochrane Collaboration's bias risk tool will be used for assessing the bias of included RCTs. Stata 17.0 software is used for meta-analysis.
Topics: Humans; Tension-Type Headache; Acupuncture, Ear; Reproducibility of Results; Systematic Reviews as Topic; Meta-Analysis as Topic
PubMed: 36482643
DOI: 10.1097/MD.0000000000031826 -
BMJ Open Nov 2018To investigate associations between different types of headaches and shift work.
OBJECTIVES
To investigate associations between different types of headaches and shift work.
DESIGN, PARTICIPANTS AND OUTCOME MEASURES
Nurses with different work schedules (day work, two-shift rotation, night work, three-shift rotation) participated in a cohort study with annual surveys that started in 2008/2009. In 2014 (wave 6), a comprehensive headache instrument was included in the survey, in which 1585 nurses participated. Headaches were assessed according to the International Classification of Headache Disorders IIIb. Frequent headache (≥1 day per month), migraine, tension-type headache, chronic headache (headache >14 days per month) and medication-overuse headache (chronic headache + acute headache medication ≥10 days last month) comprised the dependent variables. Adjusted (for sex, age, percentage of full-time equivalent, marital status, children living at home) logistic regression analyses were conducted with work schedule, number of night shifts worked last year, number of quick returns (<11 hours in-between shifts) last year, shift work disorder and insomnia disorder as predictors.
RESULTS
Frequent headache, migraine and chronic headache were associated with shift work disorder (OR 2.04, 95% CI 1.62 to 2.59; 1.60, 1.21 to 2.12; 2.45, 1.25 to 4.80, respectively) and insomnia disorder (OR 1.79, 95% CI 1.43 to 2.23; 1.55, 1.18 to 2.02; 3.03, 1.54 to 5.95, respectively), but not with work schedule, number of night shifts or number of quick returns. Tension-type headache was only associated with >20 night shifts last year (OR 1.41, 95% CI 1.07 to 1.86). Medication-overuse headache was only associated with insomnia disorder (OR 7.62, 95% CI 2.48 to 23.41).
CONCLUSIONS
We did not find any association between different types of headaches and work schedule. However, tension-type headache was associated with high number of night shifts. Nurses with sleep disorders (insomnia disorder and shift work disorder) reported higher prevalence of frequent headaches, migraine, chronic headache and medication-overuse headache (only insomnia) compared with nurses not having insomnia disorder and shift work disorder, respectively.
Topics: Adult; Cross-Sectional Studies; Female; Headache; Headache Disorders, Secondary; Humans; Male; Migraine Disorders; Norway; Nurses; Odds Ratio; Personnel Staffing and Scheduling; Shift Work Schedule; Sleep Disorders, Circadian Rhythm; Sleep Initiation and Maintenance Disorders; Tension-Type Headache
PubMed: 30455385
DOI: 10.1136/bmjopen-2018-022403 -
Scandinavian Journal of Pain Jan 2023We aimed to investigate whether coexistent self-reported neck pain influences cephalic and extracephalic pain sensitivity in individuals with migraine and tension-type...
Pain sensitivity in relation to frequency of migraine and tension-type headache with or without coexistent neck pain: an exploratory secondary analysis of the population study.
OBJECTIVES
We aimed to investigate whether coexistent self-reported neck pain influences cephalic and extracephalic pain sensitivity in individuals with migraine and tension-type headache (TTH) in relation to diagnosis and headache frequency.
METHODS
A population of 496 individuals completed a headache interview based on ICHD criteria, providing data collected by self-administered questionnaires, assessments of pericranial total tenderness score (TTS) and pressure pain thresholds (PPT). Stimulus-response (SR) functions for pressure vs. pain were recorded. Presence of neck pain in the past year was assessed by the self-administered questionnaire. We categorized participants by primary headache type. We also categorized participants into 3 groups by headache frequency: chronic (≥15) or episodic (<15 headache days/month) headache and controls. TTS, PPTs and the area under the SR curve were compared between subgroups using Generalized Linear Models with pairwise comparisons controlling for age and sex.
RESULTS
Individuals with chronic followed by episodic headache had higher TTS than controls (overall p≤0.001). The difference between chronic and episodic headache subgroups was significant in the group with neck pain (p≤0.001) but not in the group without neck pain. In individuals with neck pain, mean TTS was higher in coexistent headache (migraine and TTH), 23.2 ± 10.7, and pure TTH, 17.8 ± 10.3, compared to pure migraine, 15.9 ± 10.9 and no headache 11.0 ± 8.3 (overall p<0.001). Temporal and finger PPTs did not statistically differ among the chronic headache, the episodic headache and controls in individuals with and without neck pain. Temporalis and trapezius SR-functions showed that tenderness was increased in individuals with chronic headache to higher degree than in those with episodic headache, and more so in those with neck pain.
CONCLUSIONS
Coexistent neck pain is associated with greater pericranial tenderness in individuals with chronic headache and to a lesser degree in those with episodic headache. Sensitization may be a substrate or consequence of neck pain and primary headache, but a longitudinal study would be needed for further clarification.
Topics: Humans; Tension-Type Headache; Pain Threshold; Neck Pain; Longitudinal Studies; Migraine Disorders; Headache; Headache Disorders
PubMed: 36137215
DOI: 10.1515/sjpain-2022-0030 -
BMJ (Clinical Research Ed.) Jan 2008
Review
Topics: Counseling; Humans; Life Style; Patient Education as Topic; Prognosis; Referral and Consultation; Risk Factors; Tension-Type Headache
PubMed: 18187725
DOI: 10.1136/bmj.39412.705868.AD