Chronic Tension-type Headache Research Articles

EFFICACY OF BOTULINUM TOXIN TYPE A IN REDUCING CHRONIC TENSION HEADACHE IN PATIENTS WITH TEMPOROMANDIBULAR JOINT DYSFUNCTION

There is a notable prevalence of temporomandibular joint dysfunction, reaching approximately 34% in the general population according to the recent studies. Individuals with such dysfunction often experience tension headaches due to increased tension in the masticatory muscles, a key symptom of temporomandibular joint dysfunction. Botulinum toxin type A injections into these muscles are utilized to alleviate the dysfunction, as this drug inhibits neuromuscular impulses, thereby reducing muscle tension. This study aimed to assess the efficacy of alleviating chronic tension headaches in patients with temporomandibular joint dysfunction through botulinum toxin type A injections into trigger points of the masticatory muscles. Sixty patients exhibiting signs of temporomandibular joint dysfunction and chronic tension headaches participated in the study. They were randomly assigned to either an experimental group receiving botulinum toxin type A injections or a control group receiving saline injections into the masticatory muscles. Injections were administered at sites with the highest muscle tension in the masseter and temporalis muscles. The reduction in chronic tension-type headaches was evaluated using a visual analogue pain scale. The results indicated a statistically significant decrease in headache intensity in the experimental group compared to the control group (P<0.001). Furthermore, the experimental group demonstrated significant treatment efficacy based on headache intensity before and after 12 weeks from the drug administration date (P<0.001).

Sphenopalatine ganglion stimulation: a comprehensive evaluation across diseases in randomized controlled trials

BackgroundCurrent literature extensively covers the use of sphenopalatine ganglion stimulation (SPGs) in treating a broad spectrum of medical conditions, such as allergic rhinitis, cluster headaches, and strokes. Nevertheless, a discernible gap in the systematic organization and analysis of these studies is evident. This paper aims to bridge this gap by conducting a comprehensive review and analysis of existing literature on SPGs across various medical conditions.MethodsThis study meticulously constructed a comprehensive database through systematic computerized searches conducted on PubMed, Embase, CNKI, Wanfang, VIP, and CBM up to May 2022. The inclusion criteria encompassed randomized controlled trials (RCTs) published in either Chinese or English, focusing on the therapeutic applications of SPGs for various medical conditions. Both qualitative and quantitative outcome indicators were considered eligible for inclusion.ResultsThis comprehensive study reviewed 36 publications, comprising 10 high-quality, 23 medium-quality, and three low-quality articles. The study investigated various diseases, including allergic rhinitis (AR), ischemic strokes (IS), cluster headache (CH), primary trigeminal neuralgia (PTN), pediatric chronic secretory otitis (PCSO), refractory facial paralysis (RFP), chronic tension-type headache (CTTH), as well as the analysis of low-frequency sphenopalatine ganglion stimulation (LF-SPGs) in chronic cluster headache (CCH) and the impact of SPGs on Normal nasal cavity function (NNCF). SPGs demonstrate efficacy in the treatment of AR. Regarding the improvement of rhinoconjunctivitis quality of life questionnaire (RQLQ) scores, SPGs are considered the optimal intervention according to the SUCRA ranking. Concerning the improvement in Total Nasal Symptom Score (TNSS), Conventional Acupuncture Combined with Tradiational Chinese Medicine (CA-TCM) holds a significant advantage in the SUCRA ranking and is deemed the best intervention. In terms of increasing Effective Rate (ER), SPGs outperformed both conventional acupuncture (CA) and Western Medicine (WM; P < 0.05). In the context of SPGs treatment for IS, the results indicate a significant improvement in the 3-month outcomes, as evaluated by the modified Rankin Scale (mRS) in the context of Cerebral Cortical Infarction (CCI; P < 0.05). In the treatment of CH with SPGs, the treatment has been shown to have a statistically significant effect on the relief and disappearance of headaches (P < 0.05). The impact of SPGs on NNCF reveals statistically significant improvements (P < 0.05) in nasal airway resistance (NAR), nasal cavity volume (NCV), exhaled nitric oxide (eNO), substance P (SP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY). SPGs treatments for PCSO, RFP, and CTTH, when compared to control groups, yielded statistically significant results (P < 0.05).ConclusionSPGs demonstrate significant effectiveness in the treatment of AR, IS, and CH. Effective management of CCH may require addressing both autonomic dysregulation and deeper neural pathways. However, additional high-quality research is essential to clarify its effects on NNCF, PTN, PCSO, RFP, and CTTH.Systematic Review RegistrationPROSPERO, identifier CRD42021252073, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=312429.

Improving Function and Quality of Life in Patients with Chronic Neck Pain, Tension-Type Headache, and Forward Head Posture: The Role of Eyeball Exercise and Cervical Stabilization Programs

Improving Function and Quality of Life in Patients with Chronic Neck Pain, Tension-Type Headache, and Forward Head Posture: The Role of Eyeball Exercise and Cervical Stabilization Programs

РАЗРАБОТКА НОВОЙ КОНСТРУКЦИИ АРМИРОВАННОЙ ОККЛЮЗИОННОЙ ШИНЫ С ПАРАМЕТРИЗОВАННЫМ КАРКАСОМ НА ОСНОВЕ МЕДИЦИНСКИХ И ИНЖЕНЕРНЫХ ЦИФРОВЫХ ТЕХНОЛОГИЙ

Subject. Today, the use of splint therapy is an essential part of specialized dental treatment, since in recent years the number of patients with dysfunctional conditions of the dentofacial apparatus, has increased significantly. In addition, according to recent research, the use of occlusal splints as part of complex therapy is effective in the treatment of neurological diseases, such as bruxism, chronic tension-type headache, and neuromuscular syndrome. Traditionally used designs of occlusal splints have some disadvantages, such as fragility of use, insufficient rigidity, and the impossibility of relining if the patient's dental status changes. The article provides a description and clinical and laboratory stages of manufacturing the developed new design of an occlusal splint reinforced with a titanium frame. Objectives. Increasing the effectiveness of treatment of patients with functional disorders of the dentofacial system through the development and implementation of a new prosthetic construction – a combined occlusal splint with a titanium frame, using modern intellectual and medical 3D technologies. Materials and methods. Titanium alloy (Rematitan®) was chosen as the material for the frame of the occlusal splint. Manufacturing method implies the use of additive technologies, in particular, 3D-printing for obtaining a high-precision structure with a minimum cross-sectional thickness. Hot-curing acrylic plastic was used to cover the parameterized frame; it is also possible to use a light-curing composite. Results. During the study, the expediency of introducing a reinforcing component in the form of a metal frame into the construction of the occlusal splint was determined. A new design of a combined occlusal splint and a method for its manufacture were developed. Conclusion. By reinforcing the occlusal splint with a titanium frame, high structural strength, durability of use, maintainability or relocation if necessary are ensured; at the same time, due to 3D-printing, the frame has a minimal cross-sectional thickness, which practically does not affect the thickness of the structure as a whole.

Challenges in the management of new daily persistent headache at a tertiary headache center-A retrospective real-world evidence study.

In this retrospective cross-sectional real-world evidence study from the Danish Headache Center (DHC), a national tertiary headache center in Denmark, we sought to identify potential pharmacological agents for the treatment of new daily persistent headache (NDPH). NDPH is an enigmatic headache disorder with abrupt onset and chronic duration for which evidence-based treatments are lacking. NDPH is a diagnosis of exclusion, for which secondary headaches must be ruled out and the etiology remains idiopathic. The sparse investigations of this disorder have not yielded a pathophysiological basis and no effective treatment for NDPH has been found. All patients with an NDPH diagnosis at the DHC were enrolled (n = 64). First, we reviewed the records of all patients with an NDPH diagnosis to evaluate whether they fulfilled the diagnostic criteria. Next, we extracted all the trialled acute and prophylactic pharmacological interventions for the included patients. Then, pharmacological interventions that had been tried in ≥ 20 patients were analyzed post hoc with efficacy as the outcome, which was stratified in five effect categories ("no effect," "partial effect," "full effect," "partial effect and cessation due to adverse events," and "full effect and cessation due to adverse events"). Descriptive statistical analysis was performed, and the results were schematically presented (see Table2). Fifty-one patients out of 64 were found to fulfill NDPH criteria and were included in the study. The drugs tried by ≥ 20 patients were amitriptyline (n = 34), candesartan (n = 27), and mirtazapine (n = 20). No patients experienced a complete effect with these drugs while 9% (3/34), 26% (7/27), and 15% (3/20) experienced a partial effect with no adverse events that led to treatment discontinuation, respectively. The remaining patients experienced either no effect or a partial effect with adverse events leading to treatment discontinuation. In this study we add real-world evidence to suggest that prophylactic drugs conventionally used for treating chronic migraine and chronic tension-type headache have limited utility for treating NDPH; however, a partial response in 26% of patients using candesartan and 15% of patients using mirtazapine warrants further investigation in randomized double-blinded placebo-controlled trials.

New Daily Persistent Headache.

This article describes the clinical features, etiology, differential diagnosis, management, and prognosis of new daily persistent headache. New daily persistent headache has attracted renewed attention as it may arise in the setting of a COVID-19 infection. Spontaneous intracranial hypotension, particularly from CSF-venous fistulas, remains an important secondary headache disorder to consider before diagnosing new daily persistent headache. Symptomatic treatment for new daily persistent headache may include acute and preventive therapies used for migraine and tension-type headache, such as triptans, oral preventive agents, onabotulinumtoxinA, and agents that target calcitonin gene-related peptide. New daily persistent headache is a daily headache syndrome that starts acutely and can only be diagnosed after 3 months have elapsed and other secondary and primary headache diagnoses have been excluded. The clinical manifestations largely resemble either chronic migraine or chronic tension-type headache. The underlying cause is unknown, but it is plausible that multiple etiologies exist and that it is not a single disease entity. The prognosis is variable but often poor, and the treatment approach is largely extrapolated from the management of chronic migraine and chronic tension-type headache.

Association of Tension Headache with Anxiety among Medical Students of Lahore, A Cross-Sectional Study

Background: The prevalence of anxiety and tension-type headaches among medical students has become a topic of growing concern, given the rigorous demands of medical education. Anxiety, characterized by feelings of worry, nervousness, or unease, has been closely linked with the occurrence of tension-type headaches, a common condition manifesting as bilateral, pressing pain in the head. The intersection of these conditions within the medical student population necessitates a deeper investigation to elucidate potential associations and contributing factors. Objective: This study aimed to explore the association between chronic tension-type headaches and anxiety among medical students in Lahore, focusing on the prevalence of these conditions and identifying any significant correlations between them. Methods: A descriptive, cross-sectional study was conducted among 370 medical students in Lahore using convenient sampling. Data collection spanned from May 2020 to October 2020. Participants' anxiety levels were assessed using the Hamilton Anxiety Rating Scale, and tension-type headaches were evaluated based on criteria from the International Classification of Headache Disorders-3. Statistical analysis was performed using SPSS version 25, with a significance level set at p < 0.05. Results: The mean age of participants was 20.98 ± 1.8911 years, with 54.05% being female. The prevalence of chronic tension-type headaches was 72.97%, while anxiety levels were classified as mild (30.27%), moderate (32.97%), and severe (36.76%). A significant positive correlation (r = .348, p < .000) was observed between chronic tension-type headaches and anxiety levels among the medical students. Conclusion: The findings indicate a high prevalence of both chronic tension-type headaches and anxiety among medical students, with a significant association between these conditions. This underscores the need for medical educational institutions to implement comprehensive mental health and wellness programs to address these issues effectively.

Effects on temporomandibular disorder in the treatment of tension-type headache with acupuncture and therapeutic exercises. A secondary analysis from a randomized controlled trial

Objectives To examine the effects of acupuncture and therapeutic exercise alone and in combination on temporomandibular joint symptoms in tension-type headache and to evaluate the potential interaction of existing temporomandibular dysfunction on the success of headache treatment. Design Pre-planned secondary analysis of a randomized controlled, non-blinded trial. Setting Outpatient clinic of a German university hospital. Subjects Ninety-six Participants with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups. Interventions Six weeks of acupuncture or therapeutic exercise either as monotherapies or in combination, or usual care. Follow-up at 3 and 6 months. Main measures Subjective temporomandibular dysfunction symptoms were measured using the Functional Questionnaire Masticatory Organ, and the influence of this sum score and objective initial dental examination on the efficacy of headache treatment interventions was analyzed. Results Temporomandibular dysfunction score improved in all intervention groups at 3-month follow-up (usual care: 0.05 [SD 1.435]; acupuncture: −5 [SD 1.436]; therapeutic exercise: −4 [SD 1.798]; combination: −3 [SD 1.504]; P = 0.03). After 6 months, only acupuncture (−6 [SD 1.736]) showed a significant improvement compared to the usual care group (P < 0.01). Subjective temporomandibular dysfunction symptoms had no overall influence on headache treatment. Conclusions Only acupuncture had long-lasting positive effects on the symptoms of temporomandibular dysfunction. Significant dental findings seem to inhibit the efficacy of acupuncture for tension-type headache.

Disease-Related Factors Associated with Acupuncture Response in Patients with Chronic Tension-Type Headache: A Secondary Analysis of A Randomized Controlled Trial.

To explore the demographic and disease-related factors associated with acupuncture response in patients with chronic tension-type headache (CTTH). Using data from a randomized clinical trial (218 cases) consisting of 4 weeks of baseline assessment, 8 weeks of treatment, and 24 weeks of follow-up, participants were regrouped into responders (at least a 50% reduction in monthly headache days at week 16 compared with baseline) and non-responders. Twenty-three demographic and disease-related factors associated with acupuncture response in 183 participants were analyzed by multivariable logistic regression. One hundred and nineteen (65.0%) participants were classified as responders. Four factors were significantly independently associated with acupuncture response, including treatment assignment, headache intensity at baseline, and 2 domains [general health (GH) and social functioning (SF)] from the 36-Item Short Form Health Survey quality of life questionnaire. Treatment assignment was associated with non-response: participants receiving true acupuncture were 3-time more likely to achieve a CTTH response than those receiving superficial acupuncture [odds ratio (OR) 0.322, 95% confidence interval (CI) 0.162 to 0.625, P=0.001]. Compared with patients with mild-intensity headache, patients with moderate-intensity headache were twice as likely to respond to acupuncture (OR 2.001, 95% CI 1.020 to 4.011, P=0.046). The likelihood of non-response increased by 4.5% with each unit increase in the GH grade (OR 0.955, 95% CI 0.917 to 0.993, P=0.024) while decreased by 3.8% with each unit increase in the SF grade (OR 1.038, 95% CI 1.009 to 1.069, P=0.011). Greater headache intensity, lower GH score, and higher SF score were associated with better acupuncture responses in CTTH patients. These 3 factors require independent validation as predictors of acupuncture effectiveness in CTTH.

The relationship between myofascial trigger points sensitivity, cervical postural abnormality, and clinical tension-type headache parameters

ABSTRACT Background Myofascial Trigger Points (MTrPs) play a significant role in the pathogenesis of Tension Type Headache (TTH). Abnormal cranio-cervical posture has been linked to various types of headaches. However, the correlation between MTrPs sensitivity, cervical postural alignment, and clinical measures of headache has not been extensively studied in patients with TTH. Objectives To investigate the relationship between MTrPs sensitivity in cervical and pericranial muscles, cervical postural abnormality, and clinical headache parameters in patients with TTH. Furthermore, to investigate the effect of sex on the examined variables and their association with headache type (episodic vs chronic TTH). Methods A total of 72 patients with TTH of both sexes were enrolled in this study. Headache frequency and disability as clinical measures of headache, pressure pain threshold (PPT) of bilateral upper trapezius (UT) and suboccipital (SUB) muscles, cervical lordosis angle (CA), and anterior head translation (AHT) were measured. Results Pericranial MTrPs sensitivity did not demonstrate any correlation with clinical headache parameters or cervical postural abnormality. However, there was a significant correlation between the frequency of headaches and the level of disability (r = 0.32, P < 0.05). In addition, episodic TTH was more prevalent in females who exhibited greater AHT and MTrPs sensitivity of both bilateral UT and right SUB muscles than males. Conclusions There was no correlation found between the frequency of headaches and the level of disability with measures of cervical posture alignment or MTrPs sensitivity in individuals with TTH.. Based on findings, Clinicians should consider sex differences when assessing patients with TTH.

Examining the Impact of Puberty on Primary Headache Disorders in Female Schoolchildren: A Cross-Sectional Study.

Introduction and aim Headaches are one of the most prevalent childhood disorders. Primary and secondary headaches are the two types of headaches affecting kids and teenagers. The three most typical primary headache forms are tension-type headaches (TTH), migraine, and cluster headaches. This study sought to determine the relationship between puberty and types of headaches. Methods This cross-sectional study was conducted from May 18 to July 31, among female schoolchildren aged between eight and 15 years in the Eastern Province of Saudi Arabia. Respondents were recruited through face-to-face interviews. A self-administered questionnaire was utilized, mainly consisting of demographic data and questions related to diagnosing and managing the impact of puberty in girls on the prevalence of primary headache disorder. Results In total, 481 female schoolchildren were interviewed, mostly between 13 and 15 years old (65.9%). Last year prevalence of headaches was 65.5%, with a significant difference among those who lived in Dhahran (p=0.001) and those with a family history of headaches (p<0.001). The most common type of headache was frequent TTH (16.4%) and chronic TTH (16%). Chronic TTH (p<0.001), frequent TTH (p<0.001), and migraine without aura (p=0.005) were significantly more common among the older age groups. Conclusion There was a high prevalence of headaches among female schoolchildren, with frequent TTH and chronicTTH being the most common. Furthermore, increasing age was associated with an increasing risk for chronic TTH, frequent TTH, and migraine headaches without aura. More epidemiological studies are necessary to determine the underlying causes of headaches among schoolchildren.

A study of cardiovascular reflex tests in adults with chronic migraine and chronic tension-type headache

Background: Autonomic function tests can be used by patients with chronic migraine and chronic tension-type headaches (TTH) as a non-invasive, sensitive, and reliable marker for evaluating heart function. Studies have demonstrated sympathetic and parasympathetic dysfunction. Patients with migraines experience sympathetic and parasympathetic nervous system hyperfunction, while tension headache sufferers experience the opposite. Aims and Objectives: Parasympathetic reactivity tests will be used in the current study to evaluate the cardiac autonomic functioning in patients with chronic migraine and chronic TTH in the adult age group. Materials and Methods: Two groups of headache patients were enrolled: Those with chronic migraine (n=25) and those with chronic TTH (n=25). To conduct statistical analyses, SPSS version 21 was used. For parameters with normal and abnormal distributions, the unpaired t-test and Mann–Whitney U-test, respectively, were employed. Results: Out of 25 subjects, parasympathetic reactivity tests such as Valsalva ratio (1.38±0.10 vs. 1.49±0.19, P=0.022*) and expiratory-inspiratory ratio (1.18±0.03 vs. 1.25±0.77, P=0.000*) in chronic migraine were significantly decreased as compared to chronic TTH. Lying to standing 30:15 ratio (1.15±0.08 vs. 1.19±0.10, P=0.090) and delta heart rate (14.56±1.39 vs. 14.96±1.43, P=0.320) was decreased in chronic migraine as compared to chronic TTH but was not significant. Conclusions: In contrast to the chronic TTH group, the chronic migraine group’s total parasympathetic tone was reduced. We therefore draw the conclusion from the findings that regular monitoring of the parasympathetic reactivity can be very helpful in predicting cardiovascular risk for these patients in addition to advising the treatment practices for chronic migraine and chronic TTH, which include regular exercise and medication.

The effect of insomnia correction on the duration and severity of headaches

Introduction. Chronic tension headache and insomnia are a common mutually aggravating pathology. Drugs used to treat these nosologies most often worsen the course of the concomitant disease.Objective. To evaluate the effect of insomnia correction on the intensity and frequency of headachesMaterials and methods. The study involved 27 patients (25 women, 2 men) with chronic tension-type headache and sleep disorders. The median age was 43 ± 14.8 years. In accordance with the purpose of the study, the clinical group was divided into 2 subgroups. The first group was treated with venlafaxine and doxylamine, the patients of the second group received only venlafaxine treatment. The assessment was carried out before the start of treatment and 8 weeks after, using visual analogue scales for headache, sleep, health status, assessing the severity of insomnia using the Morin scale and the Pittsburgh Sleep Quality Inventory (PSQI), assessing the emotional state using the Sheehan anxiety and Beck depression scales and polysomnography.Results. In subgroup 1, which received correction of insomnia, there was a significant decrease in the number of days with headache (from 20 to 10, p = 0.002), pain intensity according to VAS (from 7 to 6, p = 0.01) and VAS sleep (from 6 to 4 points, p = 0.003). In the group without correction of insomnia, the number of days with headaches significantly decreased (from 15 to 12, p = 0.01), changes in the severity of headache according to VAS (from 7.5 to 6, p = 0.13) and sleep quality (from 6 to 7.5, p = 0.38) did not have a statistically significant difference. According to the results of polysomnography, patients who received correction of insomnia had an increase in the duration of slow-wave sleep by 12 minutes (p = 0.02), while in patients from the second subgroup by 4 minutes (p = 0.68).Conclusions. The use of a combination of venlafaxine and doxylamine in the first stages of treatment of patients with chronic tension-type headache and insomnia has an advantage over standard therapy. Combination therapy can reduce the intensity and frequency of headaches and improve sleep quality.

Differences in musculoskeletal dysfunctions and in postural alterations between chronic migraine and chronic tension type headache: A cross-sectional study

ObjectiveThe aim of present study is to assess postural alterations and musculoskeletal dysfunctions over all spine in patients with chronic migraine and chronic tension type headache, moreover to highlight the differences between these two forms of primary headache. MethodsA Cross sectional study was adopted to evaluate the musculoskeletal profile in patients with chronic migraine and with chronic tension type headache. The Bio photogrammetric evaluation was performed using the postural assessment software PAS/SAPO, while unilateral passive accessory intervertebral motion (PAIMs) were applied for manual examinations of spine segments from C0 to L5 vertebra. The One-way Analysis of Variance (ANOVA) test was used to compare the three groups with the software GraphPad InStat 3.06. ResultsA total of 60 patients were recruited, 20 for chronic tension type group, 20 for chronic migraine group and 20 healthy controls. The most interesting findings was that patients with chronic primary headaches presented postural alterations in all parameters (cranio-vertebral angle and lumbar-pelvic angle) and musculoskeletal dysfunctions in all spine with respect to healthy controls. Finally, the most clinically relevant finding was that no differences were found between chronic migraine and chronic tension type headache concerning the postural alterations nor the musculoskeletal dysfunctions. ConclusionThe sensitization acts as a substrate or consequence of these musculoskeletal dysfunctions in chronic primary headache. Therefore, non-pharmacological treatments targeted in the musculoskeletal system may be a good option in the management of chronic primary headache, especially when these therapies integrate various techniques that involve all spine.

Multimodal treatment, including extracorporeal shock wave therapy, for refractory chronic tension-type headache: a case report

BackgroundFew reports have described multidisciplinary treatment, including extracorporeal shock wave therapy, for patients with refractory chronic tension-type headache. In this study, we conducted multidisciplinary treatment for a patient with chronic tension-type headache who suffered from chronic headache refractory to treatment.Case presentationThe patient was a 45-year-old Japanese male suffering from 20 years of headache. As his headache had worsened recently, he visited a local clinic. With the diagnosis of suspected tension-type headache, its treatment was unsuccessful and he was referred to our hospital. The neurology department confirmed the tension-type headache and prescribed another medication, but he showed no improvement. Then, the patient was referred to the rehabilitation medicine department for consultation. At the initial visit, we identified multiple myofascial trigger points in his bilateral posterior neck and upper back regions. At the initial visit, he was prescribed 10 mL of 1% lidocaine injected into the muscles in these areas. In addition, he received 2000 extracorporeal shock wave therapy into bilateral trapezius muscles, and was instructed to take oral Kakkonto extract granules, benfotiamine, pyridoxine hydrochloride, and cyanocobalamin. Cervical muscle and shoulder girdle stretches and exercises were also recommended. At follow-up treatment visits, we used extracorporeal shock wave therapy to bilateral trapezius muscles, which led to immediate pain relief. After 11 weeks, he was not taking any medication and his headache was subjectively improved and his medical treatment ended.ConclusionA patient with chronic tension-type headache refractory to regular treatment was successfully treated with a multimodal approach including extracorporeal shock wave therapy in addition to standard treatment. For patients with tension-type headache accompanied by myofascial trigger points, it may be recommended to promptly consider aggressive multimodal treatment that includes extracorporeal shock wave therapy.

Relationship between health literacy and attitudes toward acupuncture: A web-based cross-sectional survey with a panel of Japanese residents.

The relationship between health literacy of Japanese people, their attitudes toward acupuncture, and their behavior in choosing this therapy is currently unclear. Therefore, for this study, we conducted a web-based survey to address this unknown relationship. A questionnaire comprising four categories (health status, health literacy, previous acupuncture experience, and attitudes toward acupuncture) was administered to 1,600 Japanese participants. For this study, we performed cross-tabulation and path analysis to examine the relationship between each questionnaire item. The mean score of participants' health literacy was 3.41 (SD = 0.74), and older, educated, female participants tended to have higher health literacy. The respondents perceived acupuncture to be effective for chronic low back pain, tension-type headache, and knee pain due to osteoarthritis (40.0%, 38.7%, and 21.8%, respectively). Contrastingly, acupuncture was perceived as far less effective for postoperative nausea/vomiting and prostatitis symptoms (8.3% and 8.7%, respectively). Of the total study respondents, 34.4% reported that they would try acupuncture only if recommended by clinical practice guidelines, and 35.6% agreed that acupuncture is safe. The path analysis showed that attitudes toward acupuncture were significantly influenced by the participants' health literacy, number of information sources, and previous acupuncture experience. However, it was also found that experience with acupuncture was not directly associated with health literacy. Although the Japanese population with higher health literacy is more likely to perceive acupuncture positively, they do not necessarily have sufficient relevant knowledge of the clinical evidence. Therefore, their decision to receive acupuncture may be more dependent on personal narratives rather than clinical evidence. Thus, future challenges lie in individual education of the population on how to choose a reliable health information source, and organizational efforts to provide more reliable health information.

Characteristic oscillatory brain networks for predicting patients with chronic migraine

To determine specific resting-state network patterns underlying alterations in chronic migraine, we employed oscillatory connectivity and machine learning techniques to distinguish patients with chronic migraine from healthy controls and patients with other pain disorders. This cross-sectional study included 350 participants (70 healthy controls, 100 patients with chronic migraine, 40 patients with chronic migraine with comorbid fibromyalgia, 35 patients with fibromyalgia, 30 patients with chronic tension-type headache, and 75 patients with episodic migraine). We collected resting-state magnetoencephalographic data for analysis. Source-based oscillatory connectivity within each network, including the pain-related network, default mode network, sensorimotor network, visual network, and insula to default mode network, was examined to determine intrinsic connectivity across a frequency range of 1–40 Hz. Features were extracted to establish and validate classification models constructed using machine learning algorithms. The findings indicated that oscillatory connectivity revealed brain network abnormalities in patients with chronic migraine compared with healthy controls, and that oscillatory connectivity exhibited distinct patterns between various pain disorders. After the incorporation of network features, the best classification model demonstrated excellent performance in distinguishing patients with chronic migraine from healthy controls, achieving high accuracy on both training and testing datasets (accuracy > 92.6% and area under the curve > 0.93). Moreover, in validation tests, classification models exhibited high accuracy in discriminating patients with chronic migraine from all other groups of patients (accuracy > 75.7% and area under the curve > 0.8). In conclusion, oscillatory synchrony within the pain-related network and default mode network corresponded to altered neurophysiological processes in patients with chronic migraine. Thus, these networks can serve as pivotal signatures in the model for identifying patients with chronic migraine, providing reliable and generalisable results. This approach may facilitate the objective and individualised diagnosis of migraine.

Efficacy of Jiao's scalp acupuncture in combination with Xiangshao granules on chronic tension-type headache with concomitant nonalcoholic fatty liver disease in climacteric women.

This study aimed to assess the efficacy of Jiao's scalp acupuncture in combination with Xiangshao granules on chronic tension-type headache (CTTH) with concomitant nonalcoholic fatty liver disease (NAFLD) in climacteric women. In this study, we enrolled 150 climacteric women with CTTH and concomitant NAFLD. The participants were divided into three groups based on the random number table: medication group, acupuncture group, and acupuncture-medication group. Treatment continued for 2 months. The efficacy of CTTH was assessed based on the visual analog scale/score (VAS). The influence on NAFLD was assessed based on body mass index (BMI), controlled attenuation parameter (CAP), and the ratio of hepatic-splenic computed tomography (CT) value. The Participant Health Questionnaire-9 (PHQ-9) score was compared among the three groups. A total of 123 participants completed the trial, including 37 participants in the medication group, 41 participants in the acupuncture group, and 45 participants in the acupuncture-medication group. Results are summarized hereinafter. (1) The total clinical efficiency rates of the medication group, acupuncture group, and acupuncture-medication group were 89.19% (33 of 37), 90.24% (37 of 41), and 95.65% (44 of 46), respectively. (2) Except for the BMI of the medication group (P = 0.063), a significant difference in VAS, BMI, CAP, the ratio of hepatic-splenic CT value, and PHQ-9 score was found in the three groups (P < 0.01). (3) There was a significant difference in VAS, BMI, CAP, and PHQ-9 among the three groups (P < 0.01), with those in the acupuncture-medication group being superior. No difference in the ratio of hepatic-splenic CT value was found (P = 0.440). (4) The efficacy differed significantly among the three groups (χ2 = 8.130, P = 0.017), and it was significantly superior in the acupuncture-medication group (P = 0.008, P = 0.013). Jiao's scalp acupuncture, in combination with Xiangshao granules, was superior in treating CTTH in climacteric women compared with either acupuncture or medication. Jiao's scalp acupuncture, in combination with Xiangshao granules, was superior in subsiding the negative moods in participants with CTTH and concomitant NAFLD.

Headache and psychological variables as predictors of disability in individuals with primary headache disorders.

To examine the relative contribution of headache symptoms and psychological factors to headache-related disability. Both headache symptoms and comorbid psychological factors (psychiatric symptoms and transdiagnostic constructs) negatively impact functioning among individuals with migraine and tension-type headache, but few studies have explored their relative contribution to headache-related disability. We hypothesized that psychiatric symptoms and transdiagnostic variables would afford incremental contribution to disability beyond headache symptoms, and we investigated the moderating role of headache diagnosis on these relationships. This cross-sectional study examined data from a southern U.S. university online sample of 1818 young adults (mean [SD] age 19.0 [5.1] years; 74.6% female) who met the International Classification of Headache Disorders, third edition criteria for primary headache disorders (46.6% episodic migraine, 11.6% chronic migraine, 38.3% episodic tension-type headache, 3.5% chronic tension-type headache) and completed measures assessing psychological factors and headache-related disability. Headache, psychiatric symptoms, and transdiagnostic factors were examined in relation to headache-related disability, after controlling for sex. Moderation analyses examined the conditional effect of diagnosis on disability. As predicted, both psychiatric and transdiagnostic symptoms accounted for unique variance in headache-related disability beyond headache symptoms (R2 changes of 2.7% and 2.3%, respectively). Significant three-way interactions revealed the relationship between psychiatric symptoms and disability (b = -3.16, p = 0.002), and between transdiagnostic variables and disability (b = -2.37, p = 0.034). Tests of simple slopes showed greater psychiatric symptoms and transdiagnostic variables were associated with higher levels of disability. However, the associations of these variables with disability were strongest among individuals with chronic tension-type headache (B = 3.93 for psychiatric symptoms and B = 4.62 for transdiagnostic symptoms, both p < 0.001). Psychiatric and transdiagnostic factors contribute uniquely to headache-related functional impairment, which may be important for expanding targeted assessment and behavioral interventions.

Efficacy of a strength-based exercise program in patients with chronic tension type headache: a randomized controlled trial.

Strength-based exercise is widely used to treat tension-type headache, but the evidence of its benefit is unclear. This study aims to analyze the efficacy of a strength-based exercise program in patients with chronic tension-type headaches. A randomized controlled trial with a 12-week strength-based exercise program, with chronic tension-type headache. The headache characteristics (which were the primary outcomes: frequency, duration, and intensity), cervical muscle thickness at rest or contraction of multifidus and longus-colli muscle, cervical range of motion, pain pressure threshold of temporalis, upper trapezius, masseter, tibialis muscle and median nerve, and cervical craniocervical flexion test were assessed at baseline and 12-weeks of follow-up in the intervention group (n = 20) and the control group (n = 20) was performed on 40 patients (85% women, aged 37.0 ± 13.3 years). Between baseline and week-12 of follow-up the intervention group showed statistically significant differences compared to control group in the following primary outcomes: duration and intensity of headaches. In addition, the intervention group improved the thickness of deep cervical muscles, reduced the peripheral sensitization, and improved the strength of deep cervical flexors. A 12-week strength training of neck and shoulder region induced changes in pain intensity and duration, and physical-related factors in patients with TTH. Future interventions are needed to investigate if normalization of pain characteristics and physical factors can lead to an increase of headache-related impact.