Frequent Tension-type Headache Research Articles

Effects of acupuncture and medical training therapy on depression, anxiety, and quality of life in patients with frequent tension-type headache: A randomized controlled study

To compare the effects of acupuncture and medical training therapy in combination or individually with usual care on quality of life, depression, and anxiety in patients with tension-type headache. In this single-center, prospective, randomized, controlled, unblinded trial, 96 adults (38.7(+/-13.3) years of age; 75 females/20 males/one dropout) with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups (n = 24). The treatment groups received six weeks of either acupuncture or medical training therapy as monotherapies or in combination (12 interventions each), or usual care. We assessed depressiveness (PHQ-9), anxiety (GAD-7), and health-related quality of life (SF-12) as secondary outcome parameters at baseline, six weeks, three months, and six months after initiation of treatment. Linear mixed models were calculated. Both, acupuncture (baseline to six-weeks change scores: mean: -2(standard deviation: 2.5 points), three months: -2.4(2.4), six-months -2.7(3.6)) and the combination of acupuncture and medical training therapy (-2.7(4.9), -2.2(4.0), -2.2(4.2)) (each within-group p < .05) significantly reduced depressiveness-scores (PHQ-9) to a greater extent than medical training therapy (-0.3(2.0), -0.5(1.6), -0.9(2.6)) or usual care alone (-0.8(2.9), 0.1(2.8), 0.2(3.6)). We found similar results with anxiety scores and the physical sum scores of the SF-12. No severe adverse events occurred. Acupuncture and the combination of acupuncture and medical training therapy elicit positive effects on depression, anxiety, quality of life, and symptom intensity in patients with episodic and chronic tension-type headache. Acupuncture appears to play a central role in mediating the therapeutic effects, underscoring the clinical relevance of this treatment. An additive benefit of the combination of both therapies does not appear to be relevant.Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.

Cephalgic Syndrome Correction in Pediatric Patients at the Sanatorium Treatment Stage: a Simple Randomized Prospective Study

INTRODUCTION. Diagnosis and treatment of headache in pediatric patients is of priority medical and social importance, including when correcting it at the sanatorium and health resort stage. Difficulties and problems are associated with the complexity of taking an anamnesis in children, incorrect diagnosis, comorbidity, the need for timely correction of risk factors, and the appointment of the effective pathogenetically proved treatment. AIM. To determine the structure and features of the cephalgic syndrome in pediatric patients undergoing treatment in Evpatoria sanatoriums and to determine the effectiveness of psychological correction in the treatment of patients with frequent tension-type headache by using the method of music therapy method. MATERIAL AND METHODS. As a result of a complex examination of pediatric patients, 150 patients with headache complaints were selected out of 513 examined by the method of simple random sampling. Together with a psychologist, a subgroup of 30 patients with frequent tension headaches was selected from the total number of patients after psychological testing for whom music therapy was included in the treatment plan. RESULTS AND DISCUSSION. In the structure of the cephalgic syndrome the prevalence of tension headache was revealed, while 20% of patients had frequent episodic tension headache against the background of increased anxiety and fatigability, which significantly affects quality of life and social functioning. The patients who underwent correction of tension headaches by music therapy showed improvement of extraversion indices, reduction of neuroticism, decrease of anxiety, fatigability and irritability indices, decrease of frequencyand intensity of headaches. None of the patients were diagnosed with headache according to ICHD-III in the referral diagnosis for sanatorium treatment, but were diagnosed with vegetative-vascular dystonia and other comorbidities. CONCLUSION. The obtained data of a complex examination made it possible to substantiate a pathogenetically differentiated rehabilitation course in sanatorium treatment and led to an increase in the efficiency and quality of treatment for each patient. Using the method of music therapy, emotional and psychological correction was carried out, which occupies an important place in the relief of headache in pediatric patients.

Prevalence of Tension-Type Headache among Medical Students in Tabuk University, Saudi Arabia

Background: Headaches disorders have a significant burden on the world. Tension Type Headache is the most common type among primary headaches. Since medical students are exposed to a lot of stress, and it is associated with a tension-type headache, the importance of this study comes. This study aims to measure the prevalence of tension-type headache among medical students at Tabuk University 2020.&#x0D; Methodology: A cross-sectional study in Tabuk, Saudi Arabia was conducted. The study included medical students at the University of Tabuk in the academic years from 2nd to 6th grades during the calendar year of 2020. An adapted semi-structured self-administered questionnaire was retrieved from other validated questionnaires. The internal validity and reliability of the questionnaire were tested using Cronbach's alpha test and was highly reliable (25 items, α = .715). Both medical and research experts assessed the face and content validity. The data were coded, tabulated, and analyzed using the Statistical Package for the Social Sciences (SPSS, version 27).&#x0D; Results: The total number of the students was 380 (response rate, 78.6%). 55.22% were females, and 44.78% were males their mean age was 21.18 ± SD 1.78 years. Out of the 297 students, only 122 met the diagnostic criteria. The 1-year prevalence Tension Type Headache (TTH) included the three types: frequent TTH 67.2%, 18.0% infrequent TTH, and only 14.8% suffered from chronic TTH. The most common aggravating factors included studying stressors (82%), 68% of the participants reported daily activity interference, and 48.4% reported that headache aggravate with routine physical activities (e.g., walking or climbing stairs). The headache quality varied between throbbing/pulsating (54.9%), pressing/tightening (68.9%) and sharp/stabbing (10.7%). The median headache intensity was 5.25 at pain level score (IQR =2). Only 28% of the students sought counseling where the main analgesic used was Acetaminophen (74%). Many non-pharmacological therapies were practiced by the students to relieve headache, including sleep (60.7%), rest (63.1%) and caffeine (41.8%).23% of the medical students reported that they sought medical counseling to maintain their performance level. There was a statistically significant difference between the average age of medical students suffering from frequent and infrequent TTH, t(102) = 2.31, p = .023.&#x0D; Conclusion: Tension-type headache is a prevalent type of headache among Saudi medical students. Prevalence and aggravating factors in our study were comparable to previously reported literature. Future studies with large sample size may be required among all university students to define burden of the case in Saudi Arabia.

Céphalées de tension

Tension type headache (TTH) has a higher prevalence than migraine; thus it is a frequent reason for consultation and it must not be denied. The diagnostic criteria of TTH defined by the International Classification of Headache Disorders (ICHD) are non-specific, especially allowing to contrast with migraine, because tension type headache is a heterogeneous entity of multifactorial origin. So, explorations are sometimes necessary to exclude a secondary headache. A distinction is made between infrequent and frequent episodic TTH and chronic TTH. Depending on the type of TTH studies suggest different pathophysiological mechanisms. We retain an activation of peripheral myofascial structures and a central sensitization phenomenon. The management is based on the treatment of the pain with NSAIDs, sometimes associated with a prophylactic treatment for frequent and chronic TTH. Patients suffering from chronic TTH justify multidisciplinary management to prevent the risk of chronicization and analgesics abuse.

Migraine, obesity and body fat distribution \u2013 a population-based study

BackgroundObesity has been linked to an increased prevalence of migraine, and to increased migraine attack frequency, but several questions are left unanswered by previous studies. We examined the relationship between obesity and headache in a large, population-based study where we could take into account body fat distribution, migraine subtypes and tension-type headache.MethodsThe third population-based Nord-Trøndelag Health Study (HUNT3) included validated headache questionnaires and objective anthropometric measurements. Using a cross-sectional design, our sample consisted of 18,191 women and 14,985 men, aged 19 to 96 years. Of these 4290 (12.9%) had migraine, 4447 (13.4%) had frequent tension-type headache (TTH), and 24,439 were headache-free controls. A total of 5049 individuals with unclassified headache were excluded from the analyses. Using logistic regression, we modeled the association between obesity and headache prevalence, adjusting for relevant confounders.ResultsBoth total body obesity (TBO) and abdominal obesity (AO) were associated with a higher prevalence of migraine when compared to headache-free controls (OR 1.45 95% CI 1.32–1.59 and OR 1.29 95% CI 1.18–1.41, respectively), in particular for individuals < 50 years of age (OR 1.74 95% CI 1.54–1.98 and OR 1.89 95% CI 1.69–2.11). Similar results were seen for migraine with and without aura. Similar Overall, a weaker associations were as observed between obesity and TTH. There was a dose-response relationship between obesity categories and increased headache frequency in subjects with migraine. TBO was associated with migraine prevalence and attack frequency independent of AO.ConclusionBoth TBO and AO were associated with migraine prevalence and attack frequency. This association was largely limited to individuals < 50 years of age. TBO, rather than AO, may be a better measure of obesity in relation to migraine.

Migraine and tension headache comorbidity with hypothyroidism in Egypt

BackgroundMigraine, tension type headache (TTH), and hypothyroidism are clinical problems that affect patient daily activities and quality of life.ObjectivesThe purpose of this study was to investigate the potential association between hypothyroidism in patients with migraine and TTH.Patients and methodsTwo hundred and twelve patients with migraine and TTH and one hundred control subjects underwent clinical evaluation, assessment of thyroid hormones, and thyroid ultrasound.ResultsSubclinical and overt hypothyroidism were significantly higher in patients with migraine and TTH (P = 0.001) than control subjects. Patients with migraine and TTH showed significantly more abnormal thyroid gland morphology than healthy control (P = 0.027). Hypothyroidism is significantly expressed in chronic TTH more than TTH with infrequent or frequent TTH (P = 0.009).ConclusionsPatients having migraine and TTH more prone to develop hypothyroidism when compared with control group. Also patients with chronic TTH are susceptible to develop hypothyroidism (either subclinical or overt) when compared with patients having frequent or infrequent TTH.

Prevalence and determinants of tension headache among medical students during their clinical years at King Abdulaziz University in Jeddah, 2019

Background: Tension-type headache (TTH) is the most common primary headache disorder among medical students. It affects academic performance and the quality of the student's daily lives. Objective: This study aimed to investigate the prevalence of TTH and associated factors among students at King Abdulaziz University (KAU) in Jeddah, Saudi Arabia. Methods: A cross-sectional study involved students at KAU in the academic years from 4th to 6th grades during the calendar year of 2019. For sampling purposes, we adopted a stratified proportional random sampling technique, and for data collection, we used a self-administered questionnaire. We defined TTH according to the diagnostic criteria in the third edition of the International Classification of Headache Disorders (ICHD-3b) from the International Headache Society (HIS). Results: A total of 387 medical students were approached, 50.1% were females, and 49.9% were males; their mean age was 22.8 ± SD 1.4. The lifetime TTH was 43.9%, and the 1-year prevalence TTH was 28.9%, these included both frequent TTH 25% and infrequent TTH 73%. Only 2% suffered from chronic TTH. Female sex was an unconfounded predictor for TTH, and sleeping for less than 8 hours/night was significantly associated with TTH (p Conclusion: tension-type headache is a common problem among medical students. It is highly recommended to provide a stress-free study environment, stress management courses, and relaxation programs. Keywords: Tension-type headache, Prevalence, Medical students, Saudi Arabia.

A Single Institution's Experience of Primary Headache in Children With Celiac Disease.

Few studies exist examining the frequency of primary headache in children with celiac disease and the impact of a gluten-free diet on primary headache symptomology. This study explores characteristics and frequency of headaches in children with celiac disease and response to gluten-free diet at a single institution. Medical records were reviewed for children with celiac disease confirmed by the presence of elevated tissue transglutaminase IgA levels and histologic changes consistent with the diagnosis of celiac disease on small bowel biopsy. Eligible participants were contacted via letter for participation in a phone survey regarding headaches. Phone interviews were conducted 2 weeks after notification and lasted approximately 10 minutes. Headaches were classified according to ICHD-3 criteria. 247 eligible patients or their families were contacted. A total of 132 (53.44%) agreed to participate. One participant was excluded due to insufficient information provided. Overall, 51 of 131 participants had recurrent headache defined as at least 1 episode per month (39%, 95% confidence interval [CI]: 31%-47%) and 33 had migraine with or without aura (25%, 95% CI: 18%-33%). Twenty-eight had frequent tension-type headache (22%, 95% CI: 15%-29%). Thirty-two participants noted headaches before a confirmed diagnosis of celiac disease. Twenty-two of 32 participants (68.75%) noticed decreased headache frequency or intensity, or both, after starting the gluten-free diet. This study suggests that at least one-third of children and adolescents with celiac disease have recurrent headaches at the time of diagnosis. A gluten-free diet led to improved headache symptomology in a significant number of these patients.

Primary headache characters and coping strategies among medical students of Umm Al-Qura University in the Western Region of Saudi Arabia.

Objectives:To assess the headache patterns among medical students of Umm Al-Qura College of Medicine, Makkah, Kingdom of Saudi Arabia. Medical students represent a vulnerable group for primary headache disorders, as they are exposed to various physical and psychological stressors.Methods:We carried an observational, cross-sectional study, and collected data during February, 2017 using electronic questionnaires. The international classification of headache disorders, third edition (ICHD-3) beta edition was used to classify headache into 10 types.Results:A total of 623 responses (82.2%) were received out of 758 participants. The one-year headache prevalence was 558 (89.6%). The most common diagnosis among both genders was frequent tension-type headache (TTH) (n=173, 31.0%), followed by probable infrequent TTH (n=114, 20.4%) and probable frequent TTH (n=63, 11.3%).The greatest proportions of students who reported an impact of their academic level were found among the chronic TTH, migraine without and with aura (n=2, 40.0%; n=14, 34.4%; n=11, 33.3%). Migraine without aura was more prevalent among females (n=29, 10.5%) than males (n=10, 3.5%). Self-medication was common (62.5%-100.0%). Simple analgesics (67.4%-80.0%), sleeping (54.3%-80.0%) and caffeine intake (28.3%-60.0%) were the top 3 therapies that were practiced.Conclusion:The prevalence of headache among Umm Al-Qura university (UQU), Makkah, Kingdom of Saudi Arabia’s medical students appears higher than the prevalence among the general population. This may have a significant impact on academic performance and necessitates special attention. We recommend further studies on interventions to reduce the prevalence and impact of this prevalent problem.

The effect of foetal growth restriction on the development of migraine and tension-type headache in adulthood. The HUNT Study.

BackgroundThere is little knowledge about how factors early in life affect the development of migraine and tension-type headache. We aimed to examine whether growth restriction in utero is associated with development of migraine and frequent tension-type headache in adults.MethodsThe population-based Nord-Trøndelag Health Study (HUNT 3) contained a validated headache questionnaire, which differentiated between migraine and tension-type headache. These data were linked to information on weight and gestational age at birth from the Norwegian Medical Birth Registry. In total 4557 females and 2789 males, aged 19–41 years, were included in this registry-based study. Participants were categorized as appropriate for gestational age (AGA, 10th-90th percentile), small for gestational age (SGA, 3rd-10th percentile) or very small for gestational age (VSGA, < 3rd percentile). Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) for migraine and tension-type headache, with exposure being growth restriction at birth.ResultsThe effect of growth restriction on migraine was modified by sex, with a significant association in males (p<0.001), but not in females (p = 0.20). In particular, males born VSGA were at increased risk of developing migraine (OR 2.73, 95% CI 1.63–4.58, p<0.001), with an intermediate risk among those born SGA (OR 1.50, 95% CI 0.96–2.35, p = 0.08) compared to those born AGA. There was no significant association between growth restriction and frequent TTH (p = 0.051).ConclusionGrowth restriction was associated with increased risk of migraine in adulthood among males, but not among females. This suggests that migraine might, in part, be influenced by early life events, and that males seem to be particularly vulnerable.

Migraine and frequent tension-type headache are not associated with multiple sclerosis in a Norwegian case-control study.

BackgroundInconsistent results have been obtained with regard to headache comorbidity in multiple sclerosis (MS).ObjectiveInvestigate the one-year prevalence of migraine and tension-type headache (TTH) in Norwegian MS patients and relate this to clinical parameters.MethodsA questionnaire concerning headache was administered to 756 MS patients and 1090 controls and used to determine the one-year prevalence of migraine and frequent TTH.ResultsNo significant differences were seen between patients and controls or between patients with different disease course. Less migraine was observed in patients with Expanded Disability Status Scale score (EDSS) ≥4.0.ConclusionsThis case-control study does not support an association between migraine or TTH and MS.

The PACE study: past-year prevalence of tension-type headache and its subtypes in Parma's adult general population.

The mean global prevalence of tension-type headache (TTH) in adult is 42%. To date, there have been no Italian studies on TTH prevalence in the adult general population. Therefore, we conducted a cross-sectional study, called PACE, aimed at detecting the prevalence of primary headaches in the city of Parma's adult general population. 904 subjects representative of Parma's adult general population were interviewed face to face by a physician of our Headache Centre. Crude past-year prevalence for definite TTH was 19.4% (95% CI 16.8-21.9; 18.4%, 95% CI 14.6-22.3 in men, and 20.1%, 95% CI 16.6-23.6 in women), namely, 9.0% (95% CI 7.1-10.8) for infrequent TTH, 9.8% (95% CI 7.9-11.8) for frequent TTH, and 0.6% (95% CI 0.1-1) for chronic TTH. Crude prevalence for probable TTH was 2.3% (95% CI 1.3-3.3; 2%, 95% CI 0.6-3.4 in men, and 2.6%, 95% CI 1.2-3.9 in women). Our results indicate a TTH prevalence (19.4%) at the lower limit of data ranges for Western countries, and prevalence rates for infrequent forms (9%) do not appear different from those of frequent forms (9.8%).

Prevalence of tension-type headache in adult general population: the PACE study and review of the literature

The mean global prevalence of tension-type headache (TTH) in adult is 42 %. To date, there have been no Italian studies on TTH prevalence in the adult general population. Therefore, we conducted a cross-sectional study, called PACE (PArma CEfalea, or "Headache in Parma"), aimed at detecting the prevalence and clinical features of primary headaches in the city of Parma's adult general population. Crude past-year prevalence for definite TTH was 19.4 % (95 % CI 16.8-21.9), namely 9.0 % (95 % CI 7.1-10.8) for infrequent TTH, 9.8 % (95 % CI 7.9-11.8) for frequent TTH, and 0.6 % (95 % CI 0.1-1) for chronic TTH. Crude prevalence for probable TTH was 2.3 % (95 % CI 1.3-3.3). Our study results indicate a TTH prevalence rate (19.4 %) at the lower limit of data ranges currently available for Western countries, and prevalence rates for infrequent forms (9 %) do not appear much different from those of frequent forms (9.8 %).

Effect of the Emotional Freedom Technique on Perceived Stress, Quality of Life, and Cortisol Salivary Levels in Tension-Type Headache Sufferers: A Randomized Controlled Trial

To evaluate the short-term effects of the emotional freedom technique (EFT) on tension-type headache (TTH) sufferers. We used a parallel-group design, with participants randomly assigned to the emotional freedom intervention (n = 19) or a control arm (standard care n = 16). The study was conducted at the outpatient Headache Clinic at the Korgialenio Benakio Hospital of Athens. Thirty-five patients meeting criteria for frequent TTH according to International Headache Society guidelines were enrolled. Participants were instructed to use the EFT method twice a day for two months. Study measures included the Perceived Stress Scale, the Multidimensional Health Locus of Control Scale, and the Short-Form questionnaire-36. Salivary cortisol levels and the frequency and intensity of headache episodes were also assessed. Within the treatment arm, perceived stress, scores for all Short-Form questionnaire-36 subscales, and the frequency and intensity of the headache episodes were all significantly reduced. No differences in cortisol levels were found in any group before and after the intervention. EFT was reported to benefit patients with TTH. This randomized controlled trial shows promising results for not only the frequency and severity of headaches but also other lifestyle parameters.

Survey of the differences between Migraine and MOH pre-existing migraine

Results During 7 years, 3754 patients (901 men and 2853 women, 5-93 years old) visited the clinic. At the first visit, 2034 patients (425 men and 1609 women) were diagnosed with migraine, 295 (43 men and 252 women) with migraine and frequent tension-type headache, 98 (18 men and 80 women) with migraine and chronic tension-type headache and 560 (103 men and 457 women) with MOH. Of 560 patients with MOH, MOH pre-existed migraine in 447 patients (67 men and 380 women). The average HIT6 was 63.1±6.7 for the migraine group and 65.8 for MOH pre-existing migraine. The average BMI was 20.8 for the migraine group and 21.3 for MOH pre-existing migraine. The average SDS was 40.9 for the migraine group and 44.8 for MOH pre-existing migraine. Patients with MOH pre-existing migraine experienced more occipital pain than patients with migraine (66% vs 52%). There were no differences in associated symptoms such as nausea, vomiting, photo/phonophobia between the two groups. Patients with MOH pre-existing migraine had more neck/shoulder stiffness and/or pain and reported more trigger factors such as neck/shoulder stiffness or pain, crowded places, weather changes, lack of sleep or oversleeping psychological stress than the migraine group. Patients with MOH pre-existing migraine had greater psychological disorder than the migraine group (13% vs 6%).

Psychological Issues in the Evaluation and Treatment of Tension-Type Headache

Tension-type headache is the most common headache disorder, affecting approximately 40 % of Americans within a one-year span. Although the most common form, episodic tension-type headache, is rarely impairing, more frequent tension-type headache can occur with significant disability and psychological comorbidity. Appreciating the psychological impact, assessing the associated biopsychosocial issues, and understanding patients' coping styles are important in forming an appropriate treatment plan and maximizing treatment outcomes. A range of psychological therapies including relaxation training, cognitive behavioral therapy, biofeedback and mindfulness have demonstrated utility in treating chronic pain conditions and reducing the associated disability. This may be particularly applicable to special populations, including pediatric patients, pregnant patients and geriatric. Psychological assessment and treatment may be done conjointly with medication management and expands treatment options. There is great need to continue researching the effects of psychological treatments, standardizing interventions and making them available to the wider population.

Headache in Systemic Lupus Erythematosus vs Multiple Sclerosis: A Prospective Comparative Study

To clarify whether headache, and particularly migraine, belongs to the spectrum of neurologic manifestations of systemic lupus erythematosus (SLE), the archetypal autoimmune disease. Consecutive SLE patients were matched 1:1 for age, gender, and level of education with healthy control subjects. A representative subgroup of SLE patients were also matched with patients suffering from multiple sclerosis (MS), a nervous system-specific autoimmune disease. All study participants were assessed for headache present in the previous year. Anxiety, depression, and quality of life were also estimated at baseline. During the following year, all participants were assessed every 3 months using specific headache diaries. Seventy-two SLE/control pairs and 48 MS patients completed 12 months of follow-up. Prevalence of migraine, with or without aura, was similar between SLE patients (21%), MS patients (23%), and controls (22%), as was the prevalence of frequent tension-type headache. Duration and severity of migraine attacks were milder in SLE patients than controls. Only chronic tension-type headache was significantly more prevalent in SLE patients (12.5%) compared to controls (1.4%). MS patients also presented increased frequency of chronic tension-type headache (8.3%). No associations of any headache type with particular clinical manifestations, autoantibody, or disease activity, either in SLE or MS patient groups, were found. Irrespective of the presence of headache, anxiety symptoms and impaired quality of life were more frequent among SLE than MS patients or controls. Migraine should be no longer considered a neurologic manifestation of systemic or organ-specific autoimmunity. Increased migraine prevalence in these patients found in previous studies could be due to methodological weaknesses.

Acupuncture in primary headache treatment

Acupuncture has a long tradition of use for the treatment of many pain conditions, including headache. Its effectiveness has been studied mainly for primary headaches, particularly for migraine and tension-type headache (TTH). Traditional Chinese Medicine (TCM) has two diagnostic frameworks for headaches: meridian diagnoses, based on the location of the pain and on the meridians (or channels) that pass through it; syndrome diagnoses, dependent on external or internal factors and on the characteristics of the pain. The four meridians involved in headache are Shaoyang (TE-GB channels, on the temporal sides of the head); Taiyang (SI-BL channels, occiput); Yangming (LI-ST channels, forehead) and Jueyin (PC-LR channels, vertex). The syndromes may be due to excess or deficit. Very generally, the excess syndromes correspond in the majority of cases to migraine and the deficit syndromes to TTH. Acupuncture is a complex intervention, which is also characterized by a close interaction between patient and therapist. The complicated system of TCM classification of headaches has frequently generated great diversity among the various therapeutic approaches used in the different studies on acupuncture in headache treatment. Despite these differences, the recent Cochrane systematic reviews on acupuncture in migraine and in TTH suggest that acupuncture is an effective and valuable option for patients suffering from migraine or frequent TTH. Moreover, acupuncture seems to be a cost-effective treatment.

Treating tension-type headache – an expert opinion

Introduction: Tension-type headache (TTH) is a highly prevalent disorder with enormous costs for the individual and the society.Areas covered: Nonpharmacological and pharmacological treatments are reviewed. Electromyographic (EMG) biofeedback has a documented effect in TTH, while cognitive-behavioral therapy and relaxation training are most likely to be effective. Physical therapy and acupuncture may be valuable options for patients with frequent TTH. Simple analgesics and nonsteroidal anti-inflammatory drugs are recommended for treatment of episodic TTH. Combination analgesics containing caffeine are drugs of second choice. Triptans, muscle relaxants and opioids should not be used. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is the drug of first choice for the prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine are second-choice drugs.Expert opinion: There is an urgent need for more research in nonpharmacological as well as pharmacological treatment possibilities of TTH. Future studies should examine the relative efficacy of the various treatment modalities and clarify how treatment programs can be optimized and combined to best suit the individual patient. Frequent TTH may be difficult to treat, but an acceptable result can usually be obtained by a combination of nonpharmacological and pharmacological treatments.

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

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.