Diagnosis Of Chronic Tension-type Headache Research Articles

The Effect of Flunarizine Prophylactic Treatment on Headache Frequency and Plasma Glutamate Levels in Chronic Tension-type Headache Patients

Background: Previous research has shown that flunarizine may be used for the prophylactic treatment of migraine and that plasma glutamate level monitoring in patients with migraine can serve as a biomarker of response to treatment. Our aim was to assess the efficacy of flunarizine and the correlation of glutamate levels in Chronic Tension-type Headache (CTTH) with response to medication.
 Methods: We studied 19 patients with diagnosis of CTTH according to International Classification of Headache Disorder, 2nd edition criteria. The level of plasma glutamate was measured before and after 8-weeks prophylactic treatments. Subjects were randomized into three interventional groups (flunarizine 5 mg, flunarizine 10 mg and placebo). Glutamate levels were measured by means of Glutamate ELISA Kit KA1909 Abnova. 
 Results: Flunarizine 5 mg group had lower mean plasma glutamate levels significantly compared to placebo (p < 0.00; 95% CI: 0.40-1.07). Flunarizine 10 mg group had lower mean of plasma glutamate levels significantly compared to placebo (p< 0.00; 95% CI: 0.53-1.27). However, there were no significant differences of mean plasma glutamate levels between flunarizine 5 mg group and flunarizine 10 mg group (p < 0.37; 95% CI: -(0.54) - 0.21). There were no significant differences in headache frequency reduction among the three interventional groups.
 Conclusions: The usage of flunarizine as prophylactic treatment can reduce plasma glutamate levels significantly in CTTH patients. Either flunarizine or placebo showed no significant difference in reducing headache frequency in CTTH patients.

Mix headache: A valid clinical entity?

Background:Chronic daily headache (CDH) patients respond better with a combination of anti-migraine and anti-stress medications, irrespective of clinical diagnosis of chronic migraine (CM) or chronic tension-type headache (CTTH).Hypothesis:“CDH: Mix headache” type is a valid clinical entity.Materials and Methods:A total of 70 participants fulfilling the diagnosis of “primary CDH”, aged between 15 and 55 years were taken up for the present study. All these patients were subdivided into either CM or CTTH, based on the predominance of symptom profiles in these patients, in confirmation with the International Headache Society guidelines (International Classification of Headache Disorders-2, 2004). Schedules for clinical assessment in neuropsychiatry (SCAN) were applied to these patients to collect information about any mental or behavioral symptoms present at the time of the study. Psychiatric comorbidity was confirmed according to the International Classification of Diseases (ICD)-10.Results:Forty-eight (68.6%) patients could be differentiated into CM and rest 22 (31.4%) patients were given a diagnosis of CTTH. SCAN and ICD-10 diagnosis revealed the presence of comorbid anxiety and depressive illness in 47 (67.2%) patients. Thirty-four of them belonged to CM (MH) group and the rest 13 had CTTH.Discussion:We propose that these 47 (67.2%) patients of CDH form our special category of “CDH - mix headache” subtype. Thus, 14 (20%) patients constitute “CDH - migraine” subtype and rest 9 (12.8%) patients have a diagnosis of “CDH - tension headache” subtype.Conclusion:Findings of the present study validate the concept of “mix headache” and explains the clinical observation that chronic daily headache (CDH) patients responds better with a combination of anti-migraine and anti-stress medications.

The Diagnosis and Management of Chronic Migraine in Primary Care.

Chronic migraine is common, affecting approximately 1% of the general population, and causes significant disability. To summarize optimal involvement of primary care physicians in chronic migraine care, and to provide algorithms to assist them in the diagnosis and management of patients with chronic migraine. An analysis of diagnostic and treatment needs in chronic migraine, based on a synthesis of the medical literature and clinical experience. Chronic migraine represents the more severe end of the migraine spectrum, usually arises out of previous episodic migraine, and is characterized by headache on 15 days a month or more. Importantly, the headache needs to meet migraine diagnostic criteria on only 8 days a month in order to meet chronic migraine diagnostic criteria. When acute medication overuse is present, a second diagnosis of medication overuse headache should be made. If patients meet criteria for chronic migraine, this excludes a diagnosis of chronic tension-type headache. Acute therapy of chronic migraine is similar to episodic migraine, except that medication overuse is a much greater risk in chronic migraine and must be addressed. All patients should be considered for pharmacological prophylaxis, and the behavioral aspects of therapy should be emphasized. The two prophylactic drugs with the best evidence for efficacy in chronic migraine are topiramate and onabotulinumtoxinA. Given the disability caused by chronic migraine, these should both be available to patients as necessary. Management of chronic migraine is complex, and many patients are relatively refractory to therapy. Specialist referral will often be required and should not be unduly delayed. On the other hand, the primary care physician should be able to make the diagnosis, initiate therapy, and manage some less refractory patients without referral. The timing of referral should depend both on the expertise of the primary care physician in headache management and the patient's response to initial therapy.

Chronic tension-type headache

Tension-type headache is the most common headache type worldwide. Chronic tension-type headache (CTTH) affects 2% to 3% of patients, yet it represents the least talked about subtype of chronic daily headache. There is much debate in the headache community on whether CTTH exists as its own entity or is a milder form of chronic migraine (CM), because there are similarities and differences between the two headache forms. This article reviews CTTH, as well as the current pathophysiology and treatment, and discusses controversial issues in the diagnosis of CTTH and CM.

Myofascial Trigger Points Are Very Prevalent in Patients With Chronic Tension-type Headache

Myofascial pain syndromes due to trigger points (TrPs) are clinical entities, but more evidence is needed to evaluate TrP palpation. Chronic tension-type headache (CTTH) is the most prevalent chronic headache with high socioeconomic costs. The primary aim was to study whether TrP palpation can distinguish patients with headache patients from healthy controls. Double-blinded, controlled design. Twenty patients with the diagnosis of CTTH, and 20 healthy age-matched and sex-matched control participants. TrP palpation revealed more TrPs in patients (N=17) versus controls (N=6) (P=0.0005). Referred pain was also more frequent in patients (N=17) versus controls (N=9) (P=0.04). Further, TrP palpation also identified a higher pain intensity than at a control point (CtP) in both groups (P=0.0001). Pain intensity at TrPs in patients was higher than in controls (P=0.0010), and CtPs were also more tender in patients than in controls (P=0.0167). For spontaneous electromyographic activity no difference between TrPs versus CtPs within or between groups could be detected. These findings suggest that active TrPs are much more frequent in CTTH than in controls and the number and pain intensity of TrPs may be used to distinguish between the 2 groups. Spontaneous electromyographic activity could not be demonstrated, and the underlying biology of TrPs is still unclear.

Do Investigations Reassure Patients with No Organic Pathology?

INTRODUCTION Many patients present to neurology outpatient clinics without serious pathology–the classic example is the patient with chronic headache who believes he has a brain tumour. After a history and...

Prophylactic pharmacological treatment of chronic daily headache.

To review all the prophylactic pharmacological treatments for chronic daily headache from the past decade. Chronic daily headache is among the most common diagnoses seen in specialized headache centers. Prior to 1988, there were no criteria for the diagnosis of chronic tension-type headache and chronic daily headache. An expanded chronic daily headache classification has been proposed. A MEDLINE search was performed using the following key words: chronic daily headache, intractable headache, transformed migraine, chronic tension headache, and chronic tension-type headache. We limited our review to those studies published in English in the last decade, including published abstracts and letters to the editor. Double-blind studies carried out prior to 1988 were also included. Pharmacological treatments for chronic daily headache include antidepressants (tricyclics, tetracyclics, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors), anticonvulsants, muscle relaxants, 5-HT1 agonists, ergots, 5-HT2 antagonists, antianxiety agents, and miscellaneous drugs. Many of these reports are anecdotal, and most are open rather than double-blind studies. There is a great variety of pharmacological treatments available for chronic daily headache. Only the antidepressants have been extensively studied. Other medications may be used if these fail. Recommendations based on our experience at the Headache Unit of the Montefiore Medical Center are outlined here.

Evaluation of the nosology of chronic tension-type headache.

Tension-type headache is one of the problematic classes of the IHS classification of headache. Based on the data of 211 cases of chronic tension-type headache modified criteria are proposed for the diagnosis of chronic tension-type headache. In order to provide optimal discrimination between migraine and tension-type headache it is recommended that the severity of characteristic migraine symptoms, which also frequently occur at a mild level of intensity among patients with tension-type headache, be incorporated into the diagnostic criteria for this headache. Specifically, mild photophobia and phonophobia, and headache aggravation by physical activity should not be used as exclusion criteria for tension-type headache.