An Overview of the Recent European Federation of Neurological Societies Guidelines on the Treatment of Tension-type Headache

Abstract

Tension-type headache (TTH) is the most prevalent headache type and causes a high degree of disability. This paper provides an overview of the recently published European Federation of Neurological Societies guideline on the treatment of TTH, which recommended that non-drug management should always be considered for this condition. For example: information, reassurance and identification of trigger factors may be rewarding; electromyograph biofeedback has a documented effect in TTH; cognitive-behavioural therapy and relaxation training most likely also are effective; and physical therapy and acupuncture may be valuable options for patients with frequent TTH. Simple analgesics and non-steroidal anti-inflammatory drugs are recommended for treatment of episodic TTH. Combination analgesics containing caffeine are drugs of second choice. Excessive use of analgesics should be avoided to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is the first choice for prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine may be used second line.