Episodic Tension-type Headache Research Articles

How does single-dose ibuprofen 400 mg compare with placebo for treatment of adults with episodic tension-type headache?

How does single-dose ibuprofen 400 mg compare with placebo for treatment of adults with episodic tension-type headache?

What are the benefits and harms of aspirin 1000 mg for adults with episodic tension-type headache?

What are the benefits and harms of aspirin 1000 mg for adults with episodic tension-type headache?

A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks

In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.

Evaluation of neurodynamic responses in women with frequent episodic tension type headache

BackgroundCurrent theories associated with the cause of tension type headache are mostly focused on muscle tissues. No study has investigated the presence of role of nerve tissues in this population. ObjectiveOur aim was to examine the responses to different mechanical provocation tests of the nerve tissues in women with tension type headache when compared to healthy women. DesignA case-control cross-sectional study. MethodsDifferences in range of motion and sensory responses (intensity and location) during the Passive Straight-Leg Raise Test (SLR), Long Sitting Slump test (LSS) and Seated Slump test (SLT) were assessed in 32 women with frequent episodic tension type headache (FETTH) and 32 age-matched healthy women. ResultsWomen with FETTH demonstrated bilateral and significantly reduced range of motion in all tests (P < 0.001) and also higher sensory responses in the LSS and SLT (both P < 0.001), but not in the SLR (all P > 0.422), compared to the healthy women. The location of sensory responses was also significantly different for the SLT (P < 0.05). ConclusionThe current study observed generalized lower mechanical pain thresholds to different provocation tests of the nerve tissues in women with FETTH supporting the presence of heightened nerve sensitivity to mechanical stimuli in this population. Future trials should investigate the efficacy of neurodynamic techniques in the clinical evolution of TTH.

Primary headache and migraine in headache specialists - does personal history of doctors matter?

Migraine is a common disorder affecting more than 10% of the population. The prevalence of migraine among physicians and, in particular, among headache specialists is widely unknown as is the impact of suffering from migraine on the attitudes towards migraine and on treatment recommendations of physicians. We designed a survey among headache specialists and neurologists and compared the results to general pain specialists and general practitioners. A standardized interview in randomly selected samples of these four groups of physicians was performed. The interview included data on the prevalence of migraine and other primary headache disorders in the physician groups, self-report on their own treatment, attitudes towards migraine, and treatment recommendations for migraine. The prevalence rates were also compared to an age- and sex-matched German general population sample. The lifetime prevalence of migraine was higher in headache specialists (53.0%) than in general neurologists (43.0%), pain specialists (21.7%), general practitioners (19.3%), and in the general age- and sex-matched population (16.8%). Cluster headache prevalence was high in neurologists (1.9%) and in headache specialists (1.3%); episodic tension-type headache prevalence was significantly lower in general practitioners (19.5%). One reason, among others, was that being a migraine (or cluster headache) patient more often prompted the sufferers to become a specialist in neurology. Physicians with migraine rated the biopsychosocial concept of lower importance for migraine than did physicians without migraine. The self-treatment of migraine in physicians differs from the treatment recommendations to the patients. For example, only 36.4% of the headache specialists with migraine take triptans whereas 94.4% recommend triptans to their patients. We conclude that being a headache specialist or a neurologist is associated with an increased migraine or cluster headache prevalence. This personal history of migraine leads to a more somatic view of migraine as a disorder and to different treatment recommendations as compared to self-treatment.

Widespread Pressure Pain Sensitivity over Nerve Trunk Areas in Women with Frequent Episodic Tension-Type Headache as a Sign of Central Sensitization.

Previous studies reported the presence of widespread pressure pain sensitivity in patients with tension-type headache. However, most of the studies assessed pressure pain sensitivity over muscle tissue. Our aim was to investigate the difference in pressure pain sensitivity over musculoskeletal and nerve symptomatic and distant areas between women with frequent episodic tension-type headache (FETTH) and healthy subjects. Thirty-two women with FETTH and 32 matched healthy women participated. Pressure pain threshold (PPT) was bilaterally assessed over several nerve trunks (greater occipital, median, radial, ulnar, common peroneal, tibialis posterior) and musculoskeletal structures (temporalis muscle, C5/C6 joint, tibialis anterior) by an assessor blinded to the subject's condition. A four-week headache diary was used to collect the intensity, frequency, and duration of headache. The Hospital Anxiety and Depression Scale was used to determine anxiety and depressive levels. Analysis of covariance found lower widespread and bilateral PPTs over all nerve trunks and musculoskeletal structures in women with FETTH pain (P < 0.001). No significant effect of anxiety and depressive levels on PPTs was found (all P > 0.222). PPT over the temporalis muscle was significantly negatively correlated with headache intensity. This study found widespread pressure pain hypersensitivity over both nerve trunks and musculoskeletal structures in women with FETTH, suggesting that the presence of central altered nociceptive processing is not just restricted to musculoskeletal areas, for example, muscles, but also pain evoked from directly provoking the nerve trunks by pressure. It is also possible that nerve tissue treatment could lead to a decrease in central sensitization and headache features.

Association of bruxism and anxiety symptoms among military firefighters with frequent episodic tension type headache and temporomandibular disorders.

To assess the presence of bruxism and anxiety among military firefighters with frequent episodic tension-type headache and painful temporomandibular disorders (TMDs). The sample consisted of 162 individuals aged 18 to 55 years divided into four groups. Headache was diagnosed in accordance with the International Classification of Headache Disorders-III. The Research Diagnostic Criteria for Temporomandibular Disorders questionnaire was used to classify TMDs and awake bruxism; sleep bruxism was diagnosed in accordance with the International Classification of Sleep Disorders-3; and anxiety was classified using the Beck Anxiety Inventory. In statistical models, a significance level of 95% was used. The chi-square test was used to assess anxiety. Associations were found among frequent episodic tension-type headache, painful TMDs, awake bruxism and anxiety (p < 0.0005). Sleep bruxism was not a risk factor (p = 0.119) except when associated with awake bruxism (p = 0.011). Anxiety and awake bruxism were independent risk factors for developing frequent episodic tension-type headache associated with painful TMDs; only awake bruxism was a risk factor for frequent episodic tension-type headache with non-painful TMDs.

Sleep and Tension-Type Headache.

Tension-type headache (TTH) is a common neurological condition that is related to sleep dysfunction. This review discusses recent evidence for the association between TTH and sleep disturbances. There is an increasing evidence for the association of TTH with sleep disturbances including insomnia, poor sleep quality, excessive daytime sleepiness, insufficient sleep, and shift working. Most studies have reported that sleep disturbances are more prevalent among subjects with TTH than among subjects without headaches. Clinical presentations of TTH are more exacerbated in TTH subjects with sleep disturbances than in those without sleep disturbances. Further, the close association of TTH with sleep disturbances is more robust in subjects with chronic TTH than in those with episodic TTH. Growing evidence highlights the association of TTH with psychiatric comorbidity, which is closely associated with sleep disturbances. Recent advances in our understanding of the association between sleep and TTH will help in improved diagnosis and treatment of TTH and sleep disturbances.

Comparing neck extensor muscle function in asymptomatic Canadian adults and adults with tension-type headache: a cross-sectional study

AimTo further the understanding of the pathophysiological mechanisms underlying tension-type headache (TTH) by comparing the endurance and strength of neck extensor muscles under acute muscle fatigue in participants with TTH...

Body Mass Index and Primary Headache: A Hospital-Based Study in China.

Objective Primary headache and obesity are highly prevalent disorders in the general population. Although many studies have reported an association between the two, there is still no overall comprehension about this relationship. To gain a more accurate understanding in this regard, we analyzed data from a 2011 cross-sectional study in Chongqing, China. Methods Patients with a chief complaint of headache were administered a headache questionnaire and diagnosed by neurology doctors in accordance with the International Classification of Headache Disorders 2nd Edition (ICHD-II) criteria. Patients aged < 18 years or diagnosed with secondary headache were excluded. Results Of 1327 patients who cited headache as the chief complaint, 16 were excluded for missing data, while 396 were diagnosed with chronic headache (177 chronic migraine [CM], 186 chronic tension-type headache [CTTH], and 33 other chronic headache) and 915 with episodic headache (369 episodic migraine [EM], 319 episodic tension-type headache [ETTH], and 227 other episodic headache). Chronic headache patients had a higher number of headache days per month, longer duration of headache history, and greater tendency to overuse analgesics than episodic headache patients. The CM and ETTH patients were more apt to be overweight and had a significantly greater body mass index (BMI; p < 0.05) than the EM and CTTH patients. Overweight (odds ratio [OR] = 3.64; 95% confidence interval (CI), 1.19–8.81) and obesity (OR = 28.63; 95% CI, 2.96–276.6) were independently associated with CM but not with other headaches, and this association was not influenced by other factors such as medication overuse. Conclusions The relationship between headache and overweight/obesity varies depending on the type of primary headache. CM patients are more likely to have a higher body mass index than EM patients, while ETTH patients are more likely to be overweight/obese than CTTH patients.

Catechol-O-Methyltransferase (COMT) rs4680 Val158Met Polymorphism is Associated With Widespread Pressure Pain Sensitivity and Depression in Women With Chronic, but not Episodic, Tension-Type Headache.

The aims of this study were: (1) to investigate the association between the rs4680 Val158Met polymorphism in frequent episodic tension-type headache (FETTH) and chronic tension-type headache (CTTH); and (2) to analyze the association between the rs4680 Val158Met polymorphism with clinical, psychological, or psychophysical variables. In total, 50 women with FETTH, 50 with CTTH, and 50 matched headache-free women participated. After amplifying Val158Met polymorphism by polymerase chain reaction, the genotype frequencies and allele distributions based on restriction fragment length polymorphism were assessed. Participants were classified according to the Val158Met polymorphism rs4680 genotype (Val/Val, Val/Met, or Met/Met). A headache diary collected clinical features. Disability (Headache Disability Inventory), sleep quality (Pittsburgh Sleep Quality Index), and depression/anxiety levels (Hospital Anxiety and Depression Scale) were also assessed. Pressure pain thresholds were assessed bilaterally over the temporalis, upper trapezius, second metacarpal, and tibialis anterior by a blinded assessor. The distribution of rs4680 Val158Met genotype was not significantly different between women with/without headache (P=0.796). No differences in headache features, disability, anxiety, or sleep quality were observed depending on the rs4680 Val158Met genotype. Women with CTTH, but not FETTH, carrying the Met/Met genotype had lower widespread pressure pain thresholds and higher depressive symptoms than those with Val/Val or Val/Met genotype (P<0.05). The Val158Met polymorphism (rs4680) does not appear to be involved in predisposition to tension-type headache; however, this genetic factor may be involved in the pathogenesis expression of CTTH, as greater pressure pain sensitivity and higher depressive levels were found in CTTH carrying the Met/Met genotype.

The impact of parental attitudes toward children with primary headaches.

There is a lack of data on parental attitudes toward children with primary headaches. The aim of this study is to determine whether there is a relationship between primary headaches and parental attitudes in the pre-adolescent pediatric population. In this cross-sectional study, 195 children with primary headache and 43 healthy children aged 9-16 years were included. A questionnaire for sociodemographic variables, visual analog scale (VAS), Social Anxiety Scale and Depression Inventory for Adolescents and Children, and Parental Attitudes Determining Scale (PATS), which is an attitude measure specifically designed to evaluate psychological adjustment, were administered. Of 195 children (female/male ratio: 89/106, mean age: 12.59 ± 1.09 years), episodic migraine (n = 90), chronic migraine (n = 25), and tension-type headache (n = 80) were evaluated. There was no significant difference among headache groups and healthy subjects in terms of depression, anxiety, and fathers' attitude scale scores. However, there were significant differences in mean mothers' attitude scale scores and VAS scores (p = .002, p = .000). Mean oppressive-authoritarian attitude subscale scores of mothers' was significantly higher in children with chronic migraine (p = .000). A relationship between depression and VAS scores among all patient groups was detected (p = .000). Parental age was negatively related to PATS scores of children with episodic migraine and tension-type headache (p = .037 and p = .036). Parental attitudes may elevate psychiatric symptoms and influence children's perception of pain intensity and result in chronification of headache. Our findings support that mothers' attitude toward children with chronic migraine has strong impacts on the child's pain experience.

Migraine and Episodic Tension Type Headache in School Children: Prevalence and Comparative Clinical Findings

Migraine and Episodic Tension Type Headache in School Children: Prevalence and Comparative Clinical Findings

Dipyrone for acute primary headaches

UMMARY Introduction: Headaches commonly affect working-age people. Dipyrone is largely used in many countries. Objectives: To determine effectiveness/safety of dipyrone for adults with acute primary headaches. Method: Double blind randomized controlled trials systematic review. Dichotomous data were expressed as relative risks and risk differences, and continuous data as weighted mean differences. If possible, numbers-needed-to-treat were calculated. Results: Four studies were included (636 subjects). Meta-analysis was possible for one outcome, favouring dipyrone. Regarding episodic tension-type headache and migraine, individual studies data showed dipyrone statistically significant beneficial effect. No severe adverse events were reported. There was no statistically significant difference between dipyrone and placebo regarding mild to moderate adverse events. Conclusion: Dipyrone is effective in migraine and episodic tension-type headache. Conclusions about its safety and agranulocytosis can not be drawn probably due to the relatively small sample. If the results of a recent study, which is related to the incidence of agranulocytosis in Latin America, do not clarify the question, data from observational studies on dipyrone side effects should be searched to determine its safety

Brain Hemodynamics and Cerebrovascular Reactivity in Patients with Tension-Type HeadacheAffiliation

Introduction: Tension-type headache (TTH) is very common, with a lifetime prevalence in the general population ranging in different studies between 30% and 78%. TTH, divided into episodic and chronic types, introduced in the manual "International Classification of Headache Disorders"(ICHD-I), is of practical importance. Infrequent episodic headaches (no more than once a month) may not require drug therapy, but, on the contrary, frequent forms may require expensive treatment. Objective: To study the state of cerebral hemodynamics and cerebrovascular reactivity in patients with Tension-type headache and evaluate the efficacy of treatment with Phenibite using Doppler ultrasound. Materials and Methods: A retrospective analysis of the results of ultrasound dopplerography of the anterior, middle and posterior cerebral arteries (ACA, MCA and PCA), Vertebral and Basal (VA, BA) arteries was performed in 188 patients with TTH. Among them are infrequent episodic TTH - 68 (36,2%) patients, frequent episodic TTH - 64 (34,0%) patients, chronic TTH - 56 (29,8%) patients. The age of the subjects was 18-45 years, among them 85 (45.2%) men and 103 (54.8%) women. The maximum systolic velocity (Vs), the end diastolic velocity (Vd), the resistance and pulsativity indexes (RI, PI) in all vessels were determined. Patients were given consent to participate in the study. Results: Infrequent episodic (IFE) TTH were recorded in 86.4% of cases, frequent episodic (FE) — in 88.9%, and chronic (Ch) TTH — in 81.6% of cases. Bilateral TTH was noted in 39.2%, frontal localization - in 35.6%, in the occipital region - in 25–7% of cases. The asymmetry of the maximum systolic blood flow velocity (Vs) in the paired arteries within 20-30% was considered a violation of cerebral hemodynamics, which was detected in 38.7% of patients. An increase in Vs was noted in all cerebral vessels, especially in patients with FE TTH and chronic Ch TTH compared with the control group. In patients with IFE TTH the average value of RcFMt was 1.24±0.03, in patients with FE TTH - 1.25±0.02, in patients with Ch TTH - 1.27±0.03. In patients with TTH, hyper-responsiveness to hypercapnic test was detected: RcCO2 was 1.43±0.05 in the group with FE TTH; 1.39±0.07 in the group of Ch TTH and 1.37±0.04 in the group of IFE TTH, which indicates a tendency for the tension of the vasodilator regulation mechanism even in clinically insignificant forms of TTH. In the study of reactivity to the O2-test, a hyporeactive response was observed in the groups with FE TTH and Ch TTH (0.38±0.04 and 0.35±0.05, respectively. The treatment with Phenibut carried out in a step-by-step manner - during the first week the drug was applied at a dose of 250 mg 2 times a day, over the next 6 weeks the dose increased to 500 mg 2 times a day, then the dose was reduced back to 250 mg 2 times a day. Among patients with FE TTH, the frequency of headache decreased from 5.7±2.3 to 3.6±2.1 days/month, and in patients with Ch TTH - from 22.8±1.7 to 17.7±1,3 days/month (P&lt;0,05). Influence of the drug was manifested at the initially increased RcFMt and RcCO2. A decrease in initially elevated RcCO2 was noted in all (FE TTH, ChTTH, IFETTH) clinical groups. However, this decrease was not statistically significant. Conclusion: In patients with TTH, an increase in the Vs is more often recorded, their asymmetry in the middle cerebral artery. Hyperreactivity on CO2-load is typical for patients with chronic TTH, and reflects the mobilization of metabolic regulation of cerebral blood flow. Conducting FMt was the most informative method for detecting autoregulatory disorders mainly in patients with IFE TTH. FE TTH in patients is characterized by the presence of a hyperactive reaction to hypercapnic and orthostatic tests, probably due to mobilization of humoral-metabolic and neurogenic links of regulation. In the group of patients with chronic TTH prevails hyporeactivity for hyperventilation test, reflecting the depletion of vasoconstriction reserve. The use of Phenibut(Noophen® (JSC Olainfarm Latvia in the treatment of TTH is accompanied by a decrease in the frequency of pain, and of pericranial muscle tone, most pronounced in patients with FE TTH. It's effectiveness is evident in the normalization of the coefficients of cerebrovascular reactivity in a patients with chronic TTH. The minimal statistical significance was observed on the dynamics of blood flow only in the VA.

Tension-type headache

Tension-type headache is the most common primary headache disorder. The life-time prevalence of tension-type headache in general population is between 30 to 78%. Tension-type has the tremendous socio-economic impact on the individual and the society. Unfortunately, it is the least studied primary headache. The pathophysiology of this headache disorder is not fully understood. The diagnosis of tension-type headache is based on the history, and general and neurological examinations. Abnormalities in peripheral and central nociceptive nervous systems in combination with environmental and genetic factors may play a role in the pathophysiology of tension-type headache. The pharmacotherapy of episodic tension-type headache is non-specific and includes simple analgesics and nonsteroidal anti-inflammatory drugs. Tricyclic antidepressants are the mainstay in the prophylactic treatment of chronic tension-type headache.

Psychometric properties of the Headache Under-Response to Treatment (HURT) questionnaire and the Migraine Disability Assessment Test (MIDAS) translated to Serbian

Background/Aim. The Headache Under-Response to Treatment (HURT) questionnaire and the Migraine Disability Assessment Test (MIDAS), which are intended for assessing the headache-related disability, impact (MIDAS) and management (HURT), were not yet translated to Serbian and validated in the population of Serbia. The aim of this study was to translate the HURT and MIDAS from English to Serbian, to make necessary cultural adaptations and to test their psychometric properties in a sample of outpatients with the headache. Methods. The HURT and MIDAS questionnaires were translated and adapted according to the internationally accepted guidelines, and then tested on a sample of Serbian patients with various headache types. Internal consistency was checked through the calculation of Cronbach?s alpha for the questionnaires, and by correlation of each question with the corrected total score. The criterion validity of the translation was tested by correlating scores of individual items, domains and whole questionnaire with the headache characteristics (severity, duration, frequency), and convergent validity was tested by correlating the abovementioned scores with results of an instrument for measurement of headache-related quality of life. Results. There were 171 (79.2%) females and 45 (20.8%) male study participants. The mean age of the patients was 42.3 years, (standard deviation ? SD 13.35; range 18?75); 27 (12.5%) suffered from a migraine and 189 (87.5%) from the episodic tension-type headache (TTH). The Serbian translation of HURT and MIDAS questionneires showed excellent internal consistency, with high values of the Cronbach?s alpha: 0.764 and 0.731, respectively. The validity of the instruments in all aspects (criterion, convergent and discriminant validity) was also excellent for the whole sample and for the subgroup of patients with TTH, while the results for the patients with the migraine were less favorable. The factor analysis suggested the existence of one domain of MIDAS and two domains of HURT questionneires. Conclusion. The Serbian translations of HURT and MIDAS could be used as the reliable and valid specific instruments for measuring a headache-related disability, impact (MIDAS) and management (HURT) in the patients with TTH and probably in the patients with the migraine.

Tension type headaches in children and adolescents: co-morbidity with emotional and behavioral disorders

To assess the incidence of emotional and behavioral disorders in children and adolescents with frequent episodic or chronic tension type headaches (TTH). One hundred and fifty patients with TTH (75 boys and 75 girls), aged 8-16 years, were included in the study. The severity of emotional and behavioral problems was analyzed in comparison with their healthy peers by means of parents' interviewing with the 'Strengths and Difficulties Questionnaire' (SDQ). Total difficulties scores measured by SDQ were significantly higher in boys (16.2±0.7) and girls (14.3±0.7) with TTH compared with their peers (7.9±0.4 and 7.7±0.4, respectively, p<0.001). Patients with TTH had significantly more prominent manifestations than their peers (p<0.001) on the four SDQ scales, including Hyperactivity and Inattention, Conduct problems, Emotional symptoms, Peer problems. Clinical examination revealed in many pediatric patients with TTH the following disorders: attention deficit hyperactivity disorder (45.3% boys and 13.3% girls), oppositional defiant disorder (26.7% boys, 18.7% girls), with co-occurrence of both disorders in some patients (17.3% boys, 10.7% girls). Moreover, most patients with TTH had anxiety disorders (68.0% boys, 77.3% girls). Clinical features and duration of TTH may be dependent on the severity of co-morbid emotional and behavioral disorders. This should be taken into account for individualized indication of drug therapy and non-pharmacological treatment approaches in pediatric TTH.

The efficacy of local anesthetic application to pericranial muscles in the treatment of episodic tension type headache in elderly population

The efficacy of local anesthetic application to pericranial muscles in the treatment of episodic tension type headache in elderly population

Features of the clinical picture in patients of middle age with essential hypertension.

To evaluate the presence and the severity of the complaints (headache, dizziness, memory loss, concentration of attention, sleep disturbances, decreased mood, increased anxiety), the state of cognitive functions, emotional status and quality of night sleep in treatment-naïve middle-aged patients with mild to moderate EAH compared to healthy volunteers of the same age. 103 treatment-naïve patients with EAH aged 40-59 years at the enrollment, who met the inclusion/exclusion criteria and provided written informed consent (46 men, mean age 53.6±0.8 years) and 50 healthy volunteers (17 men, mean age 51.5±1.0 years) with normal blood pressure (BP) level - control group - were enrolled to the study. Mean EAH duration was 2.9±5.7 years. Cognitive assessment included Montreal cognitive assessment, 10-words learning task, verbal fluency test, TMT, Stroop color and word test. Anxiety and depression were evaluated via Hamilton rating scales (HARS and HDRS). 24-hours ambulatory BP monitoring (ABPM) was performed according to European guidelines. 70% of patients with EAH complained of memory disturbance, 68% - lack of attention, 22% - sleep disturbances, 12% - dizziness, 9% - headache. It took statistically significant more time for patients with EAH to perform on TMT B (p<0.05), they had significantly higher TMT B - TMT A difference score (p<0.01) and lower mean MoCA score (p<0.05). Patients with EAH had significantly higher mean score in Hamilton anxiety (2.1±3.7) and depression (1.1±2.4) rating scales compared to controls (0.3±0.9 points, p<0.01 and 0.1±0.5 points, p<0.001, respectively). Patients with EAH who complained of sleep disturbances had low sleep quality (8.7±2.8 points). Among patients with EAH who complained about headaches 66.6% had episodic migraine and chronic tension type headache (33.4%). Those patients had a substantial impact of headache on life and daily living according to HIT-6 (mean score - 57.5±6.1). Only 2 patients out of 12 with complains about dizziness had benign paroxysmal positional vertigo and Ménière's disease. Complaints about memory dysfunction, lack of attention, sleep disturbances, less common - dizziness and headaches, are most typical in patients with EAH on the early stages of the disease. They differ from healthy volunteers of the same age by having cognitive impairment and higher anxiety and depression scores. Patients with EAH who complained about sleep disturbances had low sleep quality. Headache in patients with EAH was due to episodic migraine and tension type headache which had a negative impact on life and daily living.