Abstract
BackgroundPharmacological treatment of patients with tension-type headache (TTH) includes symptomatic (acute) and prophylactic (preventive) medication. No previous study has investigated variables associated to symptomatic medication intake in TTH. Our aim was to assess the association of clinical, psychological and neurophysiological outcomes with the use and timing of the use of symptomatic medication in TTH.MethodsA longitudinal observational study was conducted. One hundred and sixty-eight (n = 168) patients with TTH participated. Pain features of the headache (intensity, frequency, duration), burden of headache (Headache Disability Inventory), sleep quality (Pittsburgh Sleep Quality Index), anxiety/depression (Hospital Anxiety and Depression Scale), trait/state anxiety levels (State-Trait Anxiety Inventory), and bilateral pressure pain thresholds on the temporalis, C5-C6 joint, second metacarpal and tibialis anterior were assessed. Symptomatic medication intake was also collected for a 6-months follow-up period. Differences between patients using or not using symptomatic medication, depending on self-perceived effectiveness, and time (early during an attack, i.e., the first 5 min, or when headache attack is intense) when the symptomatic medication was taken were calculated.ResultsOne hundred and thirty-six (n = 136, 80%) reported symptomatic medication intake for headache (73% NSAIDs). Sixteen (12%) reported no pain relief, 81 (59%) experienced moderate relief and 39 (29%) total pain relief. Fifty-eight (43%) took ‘early medication’ whereas 78 (57%) took ‘late medication’. Patients taking symptomatic medication in general showed lower headache frequency and lower depressive levels than those patients not taking medication. Symptomatic medication was more effective in patients with lower headache history, frequency, and duration, and lower emotional burden. No differences in pressure pain sensitivity were found depending on the self-perceived effectiveness of medication. Patients taking ‘late symptomatic’ medication exhibited more widespread pressure pain sensitivity than those taking ‘early medication’.ConclusionsThis study found that the effectiveness of symptomatic medication was associated with better headache parameters (history, frequency, or duration) and lower emotional burden. Further, consuming early symptomatic medication at the beginning of a headache attack (the first 5 min) could limit widespread pressure pain sensitivity.
Highlights
Pharmacological treatment of patients with tension-type headache (TTH) includes symptomatic and prophylactic medication
Tension-type headache (TTH) is a pain disorder showing a prevalence of 42% in the general population [1], an important socio-economic impact [2] and a relevant social and personal burden [3]
A recent study observed that non-steroidal antiinflammatory drugs (NSAIDs) consumption in people with TTH almost reached 90% and that patient’s preferences on medication intake was slightly different from clinical guideline recommendations [10]
Summary
Pharmacological treatment of patients with tension-type headache (TTH) includes symptomatic (acute) and prophylactic (preventive) medication. The clinical practice guideline of European Federation of Neurological Societies (EFNS) recommends simple analgesics (i.e., paracetamol) and NSAIDs (i.e., ibuprofen or aspirin) as first-line for the symptomatic treatment of TTH, the episodic form [5]. This recommendation agrees with results from some Cochrane reviews reporting moderate to high evidence for the use of paracetamol (1000 mg) [6] or ibuprofen (400 mg) [7], and low to moderate evidence for the use of ketoprofen (25 mg) [8] or aspirin (500 mg–1000 mg) [9], as effective acute medications for episodic TTH. A recent study observed that NSAIDs consumption in people with TTH almost reached 90% and that patient’s preferences on medication intake was slightly different from clinical guideline recommendations [10]
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