Management Of Tension-type Headache Research Articles

Development of a Headache Diary and Assessment of Tension-Type Headache Diagnostic Criteria and Oral Behaviors, Joint Range of Motion, and Tenderness to Palpation: An Observational Study

ObjectiveThe aim of this study was to design and use a headache diary in patients with frequent tension-type headaches (TTH). Another aim was to assess the relationship among oral behaviors, range of motion, and tenderness to palpation of the craniomandibular muscles. MethodsThirty-four patients participated in this prospective observational study for a 3-month period at the Adavall Clinic for Physiotherapy and Rehabilitation (Valladolid, Spain) in 2019. Oral behaviors were collected through the Oral Behavior Checklist in the Adavall-TTH diary. Range of motion was measured in the cervical region and in the temporomandibular joint. Tenderness to palpation was measured on 38 myofascial trigger points of the craniomandibular region. ResultsOral behaviors were directly related to the pain intensity of TTH, the number of days, and the headache diagnostic criteria. Cervical range of motion was indirectly related to the intensity of TTH and the number of days of TTH (from r = −0.341 to r = −0.418, P < .05). Tenderness to palpation was associated with intensity and different diagnostic criteria of TTH in different craniomandibular muscles (from r = 0.342 to r = 0.400, P < .05). ConclusionWe found associations between examination findings and TTH diagnostic criteria. The headache diary may be a useful tool in the diagnosis and management of TTH and for analyzing the relationship between oral activities and temporomandibular joint tenderness in TTH. Future research should test the validity and reliability of this diary.

The teaching of headache medicine in France: A questionnaire-based study.

The treatment of patients with headache represents an important part of a neurologist's activity. It requires sufficient training for neurology residents. In France, residents in neurology can complete this training by attending specialized consultations or by participating in a postgraduate training program called "Diplôme Inter-Universitaire Migraine et Céphalées" (DIUMC). The objective of this cross-sectional study was to investigate the French residents' knowledge in headache medicine and the impact of different types of training in headache medicine that are available in France. An anonymous survey was carried out among 548 French residents in neurology. The questionnaires of 121 residents (22.1%) were analyzed. Among them, 54.5% (66/121) had no complementary training apart from the internship (Group 1), 21.5% (26/121) had attended only specialized consultations (Group 2), and 24% (29/121) had participated in the DIUMC (Group 3). There was no difference between all groups regarding the knowledge of the prevalence of primary or chronic headaches. There was almost no difference between the groups in the management of episodic migraine. In contrast, the management of tension-type headache and chronic headache was better known by residents of Group 3 than residents of Group 1. In these two diseases, residents of Group 3 offered prophylactic treatment more often. Almost 29% of the residents (35/121) had read the French guidelines for the diagnosis and management of migraine. In Group 3, residents had read them significantly more often (1.6% in Group 1, 38.5% in Group 2 and 62.1% in Group 3, p < 0.001). This study shows the lack of knowledge among French neurology residents regarding headache medicine. It highlights the interest of specific training programs that could improve the practical and theoretical knowledge of future neurologists.

Effect of adjunctive transcranial direct current stimulation and cognitive behavior therapy on headache disability in episodic frequent or chronic tension-type headache: A pilot, exploratory study

Background: Literature suggests that non-pharmacological treatments like non-invasive brain stimulation and cognitive behavioural therapy (CBT) may be used as augments in the management of Tension-Type Headache (TTH). Aims and Objectives: To assess the efficacy of Transcranial Direct Current Stimulation (tDCS) and Cognitive Behavioral Therapy (CBT) compared to treatment as usual (TAU) on headache-related disability and the psychological impact of headache on life of patients suffering from TTH. Materials and Methods: Thirty right-handed TTH patients HDI (headache disability index) > 30 were randomly allocated to group A (tDCS + TAU), group B (CBT + TAU), and group C (TAU). While the primary outcome measure was headache related disability (Headache Disability Index(HDI)), somatic symptoms (Somatic Symptom Severity (SSS-8)), anxiety & depression (Hospital Anxiety and Depression Scale (HADS)) and sleep quality (Pittsburgh Sleep Quality Index (PSQI). Assessments were done at baseline, end of the third and sixth month. Results: We found a statistically significant reduction in HDI (F=12.419, p <0.001), SSS-8 (F=4.587, p=0.010), and HADS-anxiety (F=4.810, p=0.002). tDCS showed better efficacy than CBT, while these two were significantly better than TAU on HDI and SSS-8. On HADS-A also both tDCS and CBT were better than TAU, but showed no significant difference between them. Conclusion: Supplementing non-pharmacological techniques like tDCS and CBT will be effective in reducing headache-related disability and associated psychological symptoms.

Use of Nutraceutical Ingredient Combinations in the Management of Tension-Type Headaches with or without Sleep Disorders.

Headache is the most common pain complaint in the pediatric population, with tension type headache (TTH) having a prevalence of 10–15% in children. Up to 70% of pediatric patients with chronic headache also experience sleep disruption, with a likely bidirectional relationship between headache and poor sleep. Treatment options include specific pharmacological approaches as well as non-pharmacological alternatives; nutraceuticals have the advantage of a relative lack of side effects. Exogenous melatonin has been shown to be useful and safe in improving sleep-wake cycles and quality of sleep in children, helping to regulate the circadian rhythm, with a secondary positive impact on headache. Supplementation with other nutraceutical ingredients, such as tryptophan, magnesium, and B vitamins, can have significant additional effects in children with primary headache, with or without sleep disorders. Tryptophan may reduce night awakenings and improve the efficiency of sleep. Primary headache has been related to low amounts of magnesium in serum, and integration with magnesium appears to be effective in reducing headache attacks without adverse effects. There are different observational reports and uncontrolled studies suggesting a possible synergistic effect for these nutraceuticals, but there is now a need for high-quality randomized controlled trials in order to confirm these positive preliminary findings.

COMPARATIVE EFFECTS OF IV INJECTION OF KETOPROFEN AND PARACETAMOL IN THE TREATMENT OF TENSION-TYPE HEADACHE

Background: Headaches are one of the commonly reported issues throughout the world population. Globally, Tension-type headache is a more common problem. Individuals facing long occurring and more severe headaches may go for care from the medical facility. However, most of the individuals do not do so which usually consequences in inappropriate and inadequate management of this problem.&#x0D; Objective: The aim of the present study is to compare the effectiveness of ketoprofen IV injection and paracetamol IV injection in the treatment of tension-type headache.&#x0D; Methodology: A validated questionnaire was designed to conduct this study. Certain inclusion and exclusion criteria were established to select the participants. Patients having the age between 20 to 40 years were treated with paracetamol and ketoprofen and their responses were recorded and evaluated.&#x0D; Results: Our results suggest that paracetamol has more vital signs stability when compared with ketoprofen and is safer in terms of drug-induced allergic reaction and injection site reaction. However, ketoprofen has a faster onset of action when compared with paracetamol.&#x0D; Conclusion: Management of tension-type headache is neglected most of the time which affects the quality of life and productivity in the affected population. Development and update of existing guidelines for tension-type headache are essential in managing this issue. Both ketoprofen and paracetamol are effective in treating this issue but both have some side effects. Future studies are still desired to further evaluate their effects.&#x0D; Keywords: Tension-type headache, Headache, analgesics, Ketoprofen, Paracetamol

Physical Treatments Reduce Pain in Children with Tension-Type Headache: A Systematic Review and Meta-Analysis.

To assess the effectiveness of a variety of physical treatments in the management of tension-type headache (TTH) in children. This review is reported in accordance with the PRISMA guidelines and was registered in the PROSPERO database (CRD42014015290). Randomized and nonrandomized controlled trials that examined the effects of all treatments with a physical component in the management of TTH in children and compared these treatments to a placebo intervention, no intervention, or a controlled comparison intervention were included. The Physiotherapy Evidence Database (PEDro) criteria for bias assessment and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group criteria were used to assess the quality of the body of evidence. The outcome measures were pain, functioning, and quality of life. Only RCTs were included in the meta-analyses. An initial search produced 10,464 published articles. Of these, 17 were relevant trials, including 1,815 participants. The overall GRADE rating of the included studies was moderate, and 11 of the 17 studies could be used in the meta-analyses. The effectiveness of physical treatments in terms of a reduction of pain of 50% or more showed a risk ratio (RR) of 2.37 (95% CI: 1.69 to 3.33). Relaxation training was the most evaluated intervention and proved to be significantly effective (RR: 3.00 [95% CI: 1.94 to 4.63]). In children having TTH combined with temporomandibular disorders, occlusal appliances were effective (RR: 2.58 [95% CI: 1.37 to 4.85]). This review supports the use of physical treatments to reduce pain in children with TTH.

Osteopathic Manipulative Therapy in Patients With Chronic Tension-Type Headache: A Pilot Study.

Nonpharmacologic treatment, such as osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) may be a beneficial complementary treatment for tension-type headache. However, to the authors' knowledge, the benefit of OMTh in the management of tension-type headache has not been explored, especially chronic tension-type headache (CTTH). To investigate the effectiveness of OMTh compared with traditional treatment in reducing pain intensity, frequency, and duration of CTTH, and to evaluate the objective postural measurement of the forward head posture (FHP) as an integral parameter in the assessment of the effects of OMTh and traditional management of CTTH. Patients with CTTH were registered at the Headache Centre of Trieste in Italy. At the time of the study, none of the patients had been taking any headache prophylaxis in the past 3 months. A 3-month baseline period was recorded by all patients with an ad hoc diary. Patients were randomly placed in the test or control group using a simple randomization program in Excel (Microsoft). Patients in the OMTh group underwent a 3-month period of OMTh, and patients in the control group were treated with amitriptyline. Pain intensity, frequency, and duration of headaches, as well as FHP were analyzed. The study enrolled 10 patients (mean [SD] age, 42.6 [15.2] years) in the OMTh group and 10 patients (51.4 [17.3] years) in the control group. The final assessment of OMTh patients showed statistically significant changes in all headache parameters: pain intensity decreased from a mean (SD) score of 4.9 (1.4) to 3.1 (1.1) (P=.002); frequency decreased from 19.8 (6) to 8.3 (6.2) days per month (P=.002); and the duration of headaches decreased from 10 (4.2) to 6 (3) hours (P=.01). Significant improvement of all parameters was found in the control group as well: pain intensity decreased from a mean (SD) score of 5.9 (0.7) to 4.2 (1.75) (P=.03); frequency decreased from 23.4 (7.2) to 7.4 (8.7) days per month (P=.003); and duration decreased from 7.8 (2.9) to 3.6 (2.1) hours (P=.002). Forward head posture significantly improved in OMTh patients (P=.003). Our data suggested that OMTh may be an effective treatment to improve headaches in patients with CTTH. Our results also suggest that OMTh may reduce FHP.

COMPARISON OF TRIGGER POINT THERAPY AND CONVENTIONAL PHYSICAL THERAPY IN TENSION TYPE HEADACHES

Objective: To compare the effectiveness of trigger point release and conventional physical therapy in tension type headaches. Materials &amp; Methods: Randomized controlled trial (RCT) conducted from 18th February 2017 to 13 July 2018, at Isra institute of Rehabilitation Sciences (IIRS) Isra University, Islamabad Campus, Pakistan. A total of n=31 healthy individuals with tension type headache below the age of 50 years, were selected through non probability convenient sampling technique and randomly divided into conventional physical therapy and trigger point therapy group. The pain and Headache disability index data was compared at baseline and during and after the intervention while quality of life was measured pre and post the sessions. For within the groups changes RM-ANOVA was used and for between the groups differences independent sample t-test was used. Results: The results showed that pain was significantly reduced at the end of intervention in conventional physical therapy group as compare to trigger point therapy group (1.31±0.47 ver. 2.13±0.64, p&lt;0.001). Regarding headache disability index, at the end of intervention trigger point therapy group show better results as compare to conventional physical therapy group (32.75±12.83 ver. 53.27±26.57, p=0.01). While comparing quality of life between the groups, no significant difference was observed after intervention. Conclusion: It was concluded that both conventional physical therapy and trigger point therapy are effective in the management of tension type headache. It decreased pain and disability caused by headache but no effect on quality of life due to shorter duration of study. Keywords: Tension type headache, trigger point therapy, stretching exercises.

Insufficient Sleep in Tension-Type Headache: A Population Study.

Background and PurposeSufficient sleep is an essential part of good health and well-being. Tension-type headache (TTH) is the most common type of primary headache and has negative impacts on the quality of life and work performance. We aimed to determinethe relationship between TTH and insufficient sleep in the general population.MethodsThis study used data from the Korean Headache Sleep Study, which was a population-based survey about headache and sleep among Korean adults. Insufficient sleep was defined when the discrepancy between sleep need and average sleep duration was at least 1 hour.ResultsAmong the 2,695 included subjects, 570 (21.2%) and 727 (27.0%) were classified as having TTH and insufficient sleep, respectively. The prevalence of insufficient sleep was significantly higher among subjects with TTH than among those without headaches (28.8% vs. 20.4%). For subjects with TTH, the scores on a visual analogue scale (4.7±1.8 vs. 4.3±1.9, mean±SD) and the Headache Impact Test-6 (44.9±7.0 vs. 43.6±6.1) were much higher in subjects with insufficient sleep than in those without insufficientsleep. Multivariable analyses revealed that insomnia [odds ratio (OR)=2.1], poor sleep quality (OR=1.7), and short sleep duration (OR=6.9) were significantly associated with insufficient sleep in subjects with TTH.ConclusionsOur findings suggest that insufficient sleep is prevalent among subjects with TTH and is linked to an exacerbation of TTH. Therefore, the proper evaluation and management of sleep may lead to the better management of TTH.

Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial

Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial

A Topic Review: Is Manual Therapy Effective In The Management Of Tension Type Headaches In Primary Care?

A Topic Review: Is Manual Therapy Effective In The Management Of Tension Type Headaches In Primary Care?

Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial

ObjectiveTo evaluate the effects of a protocol involving soft tissue techniques and/or neural mobilization techniques in the management of patients with frequent episodic tension-type headache (FETTH) and those with chronic tension-type headache (CTTH). DesignRandomized, double-blind, placebo-controlled before and after trial. SettingRehabilitation area of the local hospital and a private physiotherapy center. ParticipantsPatients (N=97; 78 women, 19 men) diagnosed with FETTH or CTTH were randomly assigned to groups A, B, C, or D. Interventions(A) Placebo superficial massage; (B) soft tissue techniques; (C) neural mobilization techniques; (D) a combination of soft tissue and neural mobilization techniques. Main Outcomes MeasuresThe pressure pain threshold (PPT) in the temporal muscles (points 1 and 2) and supraorbital region (point 3), the frequency and maximal intensity of pain crisis, and the score in the Headache Impact Test-6 (HIT-6) were evaluated. All variables were assessed before the intervention, at the end of the intervention, and 15 and 30 days after the intervention. ResultsGroups B, C, and D had an increase in PPT and a reduction in frequency, maximal intensity, and HIT-6 values in all time points after the intervention as compared with baseline and group A (P<.001 for all cases). Group D had the highest PPT values and the lowest frequency and HIT-6 values after the intervention. ConclusionsThe application of soft tissue and neural mobilization techniques to patients with FETTH or CTTH induces significant changes in PPT, the characteristics of pain crisis, and its effect on activities of daily living as compared with the application of these techniques as isolated interventions.

EHMTI-0384. A double blind randomized placebo controlled trial for non-invasive dynamic trans-cutaneous electrical nerves stimulation in management of tension type headaches

Tension-type headaches (TTH) are the most common type of headaches, and new non-invasive modalities might improve their better management. Dynamic transcutaneous electrical nerves stimulation (dTENS) is one of them. We designed a protocol for a randomized double blind placebo controlled clinical trial to assess the effects of dTENS for patients with chronic TTH. dTENS is added to the standard management with no changes in routine practice. We invite for this study adolescents, adults and elderly patients who consented to participate. Specially designed headache diaries, HALT, HART indices and clinical interview are included as the major outcomes measures. The zones, intensity and duration for dTENS application were recommended and modified by physical therapist (L.G.) and acupuncture specialist (M.N.). They included the zones (on the head and neck) and dosage recommended by the manufacturer. The course of dTENS study consists of 10 procedures performed by clinicians (D.V. and G.R.) who were trained for this. All participants of the study are randomized into two groups using a computer-based software. Placebo-devices were made for this trial by the manufacturer (DENAS Corporation, Ekaterinburg, Russia). The sham-devices look and sound exactly as the active ones, but electrodes are not connected to the electrical stimulator. These compact devices for dTENS are approved for using in medical settings and at home, and this trial might add evidence for physicians when prescribing them to patients.

Amitriptyline versus tizanidine in the management of tension‐type headache in Nepal

Emergency Medicine AustralasiaVolume 25, Issue 6 p. 611-612 Case Letter Amitriptyline versus tizanidine in the management of tension-type headache in Nepal Ajay Singh Thapa, Ajay Singh Thapa Department of General Practice and Emergency Medicine, Institute of Medicine, Kathmandu, NepalSearch for more papers by this author Ajay Singh Thapa, Ajay Singh Thapa Department of General Practice and Emergency Medicine, Institute of Medicine, Kathmandu, NepalSearch for more papers by this author First published: 13 November 2013 https://doi.org/10.1111/1742-6723.12154Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume25, Issue6December 2013Pages 611-612 RelatedInformation

Effectiveness of direct vs indirect technique myofascial release in the management of tension-type headache

Tension-type headache (TTH) is essentially defined as bilateral headache of a pressing or tightening quality without a known medical cause. Myofascial release (MFR) is currently being applied for patients with TTH but its efficacy has not been evaluated formally. To investigate whether direct technique myofascial release (DT-MFR) reduces the frequency of headache more effectively than the indirect technique myofascial release (IDT-MFR) in comparison to a Control Group receiving slow soft stroking. Randomized, controlled, single blinded trial. The clinical wing of Myofascial Therapy and Research Foundation, Kerala, India. 63 patients with episodic or chronic tension-type headache. DT-MFR, IDT-MFR or Control. The techniques were administered by certified myofascial release practitioners and consisted of 24 sessions per patient over 12 weeks. Difference in numbers of days with headache between Weeks 1-4 (i.e. 4 weeks prior to start of Intervention) and Weeks 17-20, following 12 weeks of Intervention between Weeks 5-16 as recorded by participants in headache diaries. The number of days with headache per 4 weeks decreased by 7.1 (2.6) [mean (SD)] days in the DT-MFR group compared with 6.7 (1.8) days in the IDT-MFR group and 1.6 (0.5) days in the control group, (P<0.001). Patients in the DT-MFR Group, IDT-MFR Group and Control Group reported a 59.2%, 54% and 13.3% reduction in their headache frequency in Weeks 17-20 compared to that in Weeks 1-4. This study provides evidence that Direct Technique or Indirect Technique Myofascial Release is more effective than the Control Intervention for tension headache.

Acupuncture in the management of tension-type headache

The aim of this systematic review was two-fold: to assess the efficacy of acupuncture in the management of tension-type headache, and to compare three criteria lists assessing the quality of studies. Searches to selected criteria lists were carried out with no time limit using the database for the Cochrane Central Register of Controlled Trials. Articles of controlled clinical trials evaluating the efficacy of acupuncture in the management of tension-type headache were obtained by searching through the databases MEDLINE, CINAHL, EMBASE, AMED and Cochrane Central Register of Controlled Trials up to February 2003. Six articles met the criteria for inclusion and three criteria lists were used to assess the internal validity of these studies. The studies were considered to be of high quality or low quality in accordance with the criteria lists utilised. The results of the trials were considered positive, negative or indifferent based on statistically significant between group differences. The three criteria lists utilised yielded the same results and indicate that two of six studies were of high quality. Results indicated limited evidence for the efficacy of acupuncture in the management of tension-type headache. This systematic review shows that qualitative assessments by three criteria lists focusing on internal validity, gave the same results, and that there is limited evidence for the efficacy of acupuncture in the management of tension-type headache.

Behavioral and psychologic aspects of the pathophysiology and management of tension-type headache.

Behavioral and psychologic factors in tension-type headache are reviewed with reference to pathophysiology, comorbid psychiatric disorders, headache triggers, and behavioral treatment, including the efficacy of behavioral treatments, brief minimal contact administration of behavioral treatment, therapeutic mechanisms underlying the effectiveness of behavioral treatments, and the integration of drug and behavioral treatments. Anxiety or depression may contribute to central sensitization that underlies frequent tension-type headaches. Excessive analgesic use, comorbid psychiatric disorders, or persistent unaddressed headache triggers may limit the effectiveness of headache treatment. Available drug and behavioral treatments are effective for episodic tension-type headache, but are only moderately effective for chronic tension-type headaches. The combination of behavioral and preventive drug therapies may improve outcomes for patients with chronic tension-type headache.