Tension-type Headache Attacks Research Articles

Validation of a Digital Headache Calendar at a Tertiary Referral Center.

Headache calendars are essential tools in monitoring changes in headache frequency and type. They are used in clinical practice for long-term monitoring, but their validation remains limited. The aim of this study was to validate the use of a digital calendar in monitoring single migraine and tension-type headache attacks. From July 2022 to February 2023, patients diagnosed with migraine and tension-type headache were enrolled. The validation of the digital calendar involved the comparison of self-reported single headache attacks in the digital calendar with the diagnostic headache diary based on the ICHD-3 criteria for migraine and tension-type headache. Sensitivity and specificity were calculated to assess reliability, and the level of agreement was calculated using kappa statistics. This study included 30 patients (87% women) diagnosed with migraine and tension-type headache. The level of agreement in the classification of a single migraine attack revealed a sensitivity of 82% and a specificity of 78%, representing a substantial level of agreement (κ = 0.60). The classification of a single tension-type headache attack revealed a sensitivity of 84% and a specificity of 72%, with a moderate level of agreement (κ = 0.54). The digital calendar proves effective in monitoring single headache attacks in patients with migraine and tension-type headache. In clinical practice, we recommend using the digital calendar as a monitoring tool for headache patients, as they can accurately identify true migraine and tension-type headache days.

Tension-type headache in children and adolescents: comparative study of the effectiveness of preventive therapy methods

Introduction. Late and inaccurate diagnosis of tension-type headache (TTH) leads to the lack of timely rational treatment. In children and adolescents with TTH, the role of comorbid disorders that affect the course of TTH and can contribute to their chronification is not sufficiently taken into account. Meanwhile, with timely diagnosis and adequate treatment of TTH in many children and adolescents, a significant improvement in the disease’s course and the prognosis is achieved, and clinical remission is possible. Considering the high prevalence of TTH among children and adolescents, the decline in their quality of life, and the high frequency of comorbid disorders, it is reasonable to develop effective methods of preventive treatment for TTH in this age group. The aim of the study was to evaluate the effectiveness of monotherapy with γ-amino-β-phenyl butyric acid hydrochloride, amitriptyline, or breathing gymnastics (comparison group) indicated for two months as a preventive treatment of TTH in children and adolescents in the open randomized comparative study in three parallel groups of patients. Material and methods. In an open parallel study, 90 TTH patients aged 8-16 years were divided into three groups of 30 patients (each with 15 boys and 15 girls). Results. Significant differences with the comparison group in the individual response to therapy were confirmed. According to the criterion of a 50% or more reduction in the average number of headache attacks per month in group 1 (γ-amino-β-phenyl butyric acid hydrochloride), the improvement was achieved in 56.7% of patients, in group 2 (amitriptyline) - in 73.3%, in the 3rd group (breathing gymnastics) - in 30%. According to a more strict criterion for reducing the average number of headache attacks per month by 75% or more, the response to therapy was observed in group 1 in 30%. In group 2 - in 23.3%, in group 3 - in 3.3% of patients. In groups 1 and 2, along with a significant decrease in the frequency, duration, and intensity of TTH attacks, a significant improvement in daily activity, a favorable effect on the manifestations of fatigue, anxiety disorders, and sleep disorders associated with TTH was demonstrated. The therapeutic efficacy of breathing gymnastics exercises complex was confirmed in the prevention of TTH with frequency, duration, and intensity reduction of TTH, and diminishing its impact on daily activity, a moderate decrease in manifestations of fatigue, anxiety disorders (by patients’ self-assessment), and improvement in sleep quality.

Validation of an algorithm for automated classification of migraine and tension-type headache attacks in an electronic headache diary

BackgroundThis study evaluates the accuracy of an automated classification tool of single attacks of the two major primary headache disorders migraine and tension-type headache used in an electronic headache diary.MethodsOne hundred two randomly selected reported headache attacks from an electronic headache-diary of patients using the medical app M-sense were classified by both a neurologist with specialisation in headache medicine and an algorithm, constructed based on the ICHD-3 criteria for migraine and tension-type headache. The level of agreement between the headache specialist and the algorithm was compared by using a kappa statistic. Cases of disagreement were analysed in a disagreement validity assessment.ResultThe neurologist and the algorithm classified migraines with aura (MA), migraines without aura (MO), tension-type headaches (TTH) and non-migraine or non-TTH events. Of the 102 headache reports, 86 cases were fully agreed on, and 16 cases not, making the level of agreement unweighted kappa 0.74 and representing a substantial level of agreement. Most cases of disagreement (12 out of 16) were due to inadvertent mistakes of the neurologist identified in the disagreement validity assessment. The second most common reason (3 out of 16) was insufficient information for classification by the neurologist.ConclusionsThe substantial level of agreement indicates that the classification tool is a valuable instrument for automated evaluation of electronic headache diaries, which can thereby support the diagnostic and therapeutic clinical processes. Based on this study’s results, additional diagnostic functionalities of primary headache management apps can be implemented. Finally, future research can use this classification algorithm for large scale database analysis for epidemiological studies.

Clinical Profile of Primary Headaches and Awareness of Trigger Factors in Migraine Patients

Aim: To classify the patients as per the International Classification of Headache disorders 3rd edition Beta version. To study the demographic details and clinical profile. To study the trigger factors in migraine patients. To study the importance of family history is headache patients. Materials & Methods: The study was a cross sectional observational study of 300 patients at outpatient clinic tertiary health care center, over a period of two years. Patients diagnosed with primary headache were studied with help of an exhaustive questionnaire which covered the relevant details. Results: Our study had 158 migraines (MG), 137 Tension Type Headache (TTH) and 5 Trigeminal Autonomic Cephalgia (TAC) patients. Females are more affected, 1:2.9 in TTH and 1:1.5 in MG. Mean age for MG was 33.37 and for TTH were 36.11. Majority (46-48%) were employed, followed by housewives (43-38%) and students (9-13%) among both the groups. TTH patients had frequency of headache more patients than migraine patients. Family history was positive in 36% in MG and 14% in TTH patients. TTH had dull aching, holocranial pain with pericranial tenderness; whereas migraine had throbbing unilateral pain. Aura was seen only in 21% of MG patients; retinal (67%) being most common. Associated symptoms like nausea, phonophobia, photophobia were seen in 80% of MG patients. Trigger factors on history were present in 64%, which increased to 85% on showing detail list. Most common triggers were climatic, followed by travel, stress and sleep related. Females had hormonal, smell and emotional stress as more common TF. Conclusion: Migraine is most common primary headache presenting in clinics. With predominance in females TTH attacks are more frequent than migraine. TTH showed features like dull aching, pressure like and holocranial pain whereas migraine has throbbing and unilateral pain. Pericranial tenderness is more in TTH patients whereas migraine has associated vasomotor symptoms. It is important to have detail list of all Trigger factors for Migraine patients, so that they can avoid them and prevent their attacks, thus reducing analgesic use. Family history has more influence in migraine patients compared to TTH.

Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients?

Tension-type headache (TTH) is a common condition but the underlying etiology is not understood. Episodic TTH may develop into chronic TTH, and some possible triggers may be involved in generation and maintenance. Nociceptive generators and hyperexcitable spots in neck and shoulder regions may to some degree contribute to TTH. The current paper highlights some of the possible triggers and associated pain mechanisms involved in TTH and discusses whether inhibition of these possible triggers may provide new treatment options. This paper presents possible pathophysiological factors in TTH, the role of muscle pain, and how referred pain from triggers can contribute to development, maintenance of sensitization, or both. Referred pain patterns from trigger points and associated muscle hyperalgesia seem to be clinically important factors. Damping the nociceptive peripheral drive may not only reduce the number of TTH attacks but may also prevent, delay the transition from episodic into more chronic TTH, or both. The role of muscle triggers in driving TTH is debated as the pathogenesis of such triggers is not fully understood. Furthermore, inhibiting the drive from the triggers does not consistently modulate TTH. Understanding the possible triggers in TTH, muscle hyperalgesia, and widespread pain sensitization, may help to develop better management regimes and possibly prevent TTH from developing into more chronic conditions. Currently, there is a striking difference between the clinical observational studies favoring the role of muscle triggers in TTH and the intervention studies generally not supporting the role of muscle triggers in TTH.

Tension Type Headache.

Tension type headache (TTH) is the most common headache and it has been discussed for years without reaching consensus on its pathophysiology, or proper rationale management. This primary headache remains a challenge into its management for clinicians. This review aims to provide an updated and critical discussion on what is currently known and supported by scientific evidence about TTH and which gaps there still may be in our understanding of this condition. Clinical features of TTH resemble common manifestations of muscle referred pain. Episodic TTH may evolve into the chronic form by different aspects and several triggers may be involved at the same time. Both peripheral and central sensitization mechanisms seem to be clearly involved in this process. Individuals with episodic TTH exhibit higher levels of peripheral excitability whereas chronic TTH clearly show central sensitization manifestations. The role of associated muscle hyperalgesia seems to be important factors in TTH. Therapeutic management of individuals with TTH should be multimodal including appropriate use of pharmacological and non-pharmacological interventions to reduce the nociceptive peripheral drive to the central nervous system. If properly applied, treatment may not only reduce the number of TTH attacks but may also prevent or delay the transition from episodic to chronic TTH. Scientific evidence of pharmacological and nonpharmacological treatment is discussed in this review.

Alcoholic Drinks as Triggers in Primary Headaches

This project aims to investigate the role of alcoholic drinks (ADs) as triggers for primary headaches. Patients followed in the Headache Centre and presenting with migraine without aura, migraine with aura (MA), chronic migraine (CM), and tension-type headache (TH) were asked if their headache was precipitated by AD and also about their alcohol habits. Individual characteristics and drink habits were evaluated within two binary logistic models. About one half (49.7%) of patients were abstainers, 17.6% were habitual consumers, and 32.5% were occasional consumers. Out of 448 patients, only 22 (4.9%), all with migraine, reported AD as a trigger factor. None of 44 patients with MA and none of 47 patients with TH reported AD as a trigger factor. Among those patients with migraine who consume AD, only 8% reported that AD can precipitate their headache. Multivariate analyses showed that AD use, both occasional and habitual, is unrelated to TH. Moreover, analysis performed among migraine patients, points out that occasional and habitual drinkers have a lower risk of presenting with CM than abstainers, although statistical significance occurred only among occasional drinkers. Only 3% of migraine patients who abstain from AD reported that they do not consume alcohol because it triggers their headache. Our study shows that AD acts as headache triggers in a small percentage of migraine patients. Differing from some prior studies, our data suggest that AD do not trigger MA and TH attacks. Moreover, the percentage of abstainers in our sample is higher compared with that reported in general population surveys.

Acetylsalicylic acid inhibits α,β-meATP-induced facilitation of neck muscle nociception in mice — Implications for acute treatment of tension-type headache

Infusion of α,β-methylene ATP (α,β-meATP) into murine neck muscle facilitates brainstem nociception. This animal experimental model is suggested to be appropriate for investigating pathophysiological mechanisms in tension-type headache. It was hypothesized that d-lysine acetylsalicylic acid (ASA, aspirin®) reverses this α,β-meATP effect. Facilitation of neck muscle nociceptive processing was induced via bilateral infusion of α,β-meATP into semispinal neck muscles (100 nM, 20 μl each) in 42 anesthetized mice. Brainstem nociception was monitored by the jaw-opening reflex elicited via electrical tongue stimulation. The hypothesis was addressed by subsequent (15, 30, 60 mg/kg) and preceding (60 mg/kg) intraperitoneal ASA injection. Saline served as control to ASA solution. Subsequent ASA dose-dependently reversed α,β-meATP-induced reflex facilitation and was the most prominent with 60 mg/kg. Preceding 60 mg/kg ASA prevented reflex facilitation. Cyclooxygenases are involved in nociceptive transmission. Former experiments showed that unspecific inhibition of cyclooxygenases does not alter the α,β-meATP effect. This suggests a specific mode of action of ASA. The concept is accepted that neck muscle nociception is involved in the pathophysiology of tension-type headache. Thus, objective proof of ASA effects in this experimental model may emphasize its major role in pharmacological treatment of tension-type headache attacks.

Medium-dose riboflavin as a prophylactic agent in children with migraine: A preliminary placebo-controlled, randomised, double-blind, cross-over trial

Riboflavin seems to have a promising effect on migraine in adults. The present study examines whether riboflavin has a prophylactic effect on migraine in children. To investigate whether riboflavin in a dosage of 50 mg/day has a prophylactic effect on migraine attacks in young children. This randomised, placebo-controlled, double-blind, cross-over trial included 42 children (aged 6-13 years) with migraine of whom 14 children were also suffering from tension-type headache. Following a 4-week baseline period, all children received placebo for 16 weeks then riboflavin for 16 weeks (or vice versa) with a washout period of 4 weeks in between. The primary outcome measure was reduction in mean frequency of migraine attacks and tension-type headache in the last 4 weeks at the end of the riboflavin and placebo phase, compared with the preceding baseline or wash-out period. Secondary outcome measures were mean severity and mean duration of migraine and tension-type headaches in the last 4 weeks at the end of the riboflavin and placebo phase, compared with the preceding baseline or wash-out period. No significant difference in the reduction of mean frequency of migraine attacks in the last month of treatment was found between placebo and riboflavin (P = 0.44). However, a significant difference in reduction of mean frequency of headaches with a tension-type phenotype was found in favour of the riboflavin treatment (P = 0.04). In this group of children with migraine, there is no evidence that 50 mg riboflavin has a prophylactic effect on migraine attacks. We found some evidence that 50 mg riboflavin may have a prophylactic effect on interval headaches that may correspond to mild migraine attacks or tension-type headache attacks in children with migraine.

Trigger factors of migraine and tension-type headache

tating factors for both migraine and tension-type headache attacks has identified several potential triggers with percentages differing widely among studies [1–5]. They include menstrual cycle, particularly in women affected by migraine; environmental factors, especially changes in weather conditions and temperature; afferent stimulation, physical activity and psychological factors, mainly stress or relaxation from stress; sleep disturbances; frequent travelling; oral contraceptives; and finally eating habits, and some food items. According to some authors, lifetime migraineurs experienced headache attacks preceded by triggering factors more frequently than tension-type headache sufferers [5]. Moreover, certain endogenous and exogenous factors seem to differentiate migraine from tension-type headache and it is of interest to note in this regard that three of the precipitating factors considered more migraine-specific (i.e., weather, smell and smoke) involve the nose/sinus system, suggesting a greater significance of this system in migraine than is generally believed [4]. The aim of the Wober et al. [6] study was to investigate the consistency of the recurrence of precipitating factors in migraineurs and tension-type headache patients enrolled from a clinical outpatient setting and from a sample, although not conspicuous, of the general population. The authors found that the majority of trigger factors precipitate migraine and tension-type headache only occasionally and not consistently in almost the majority of cases. In contrast to previous experiences, no differences emerged in this study in the percentages of factors referred as attack precipitants between the two patient groups. The occasional occurrence of some precipitating factors in some but not all migraine and tension-type headache attacks supports the view that they can surely play a role, although not exclusively, in influencing the pathophysiological substrate underlying the threshold for attacks in both headache forms. This predisposed substrate can be, from time to time, influenced by different inner and outer stimuli. Mechanisms involved in the potentiality of different factors in precipitating attacks by activating strategic brain areas involved in the generation and abnormal processing of painful information from the head remain to be established. New imaging techniques and particular experimental settings could be helpful in clarifying this important issue, at least for some attack precipitants, as recent experiences have found [7]. J Headache Pain (2006) 7:172–173 DOI 10.1007/s10194-006-0304-4

Evaluation of the Prophylactic Efficacy of Amitriptyline and Citalopram, Alone or in Combination, in Patients with Comorbidity of Depression, Migraine, and Tension-Type Headache

Antidepressants are used to treat chronic daily headache disorders such as migraine and chronic tension-type headache (TTH), which are often associated with depression and anxiety. Here, we studied the efficacy and tolerability of amitriptyline and citalopram, given alone or in combination, in patients with ‘triple’ comorbidity of depression, TTH, and migraine. Eighty-eight patients were enrolled in the study and randomly divided into two groups. The first group received amitriptyline and the second citalopram for 16 weeks. Patients were assessed at weeks 0, 4, 8, and 16. The two drugs were equally efficacious in relieving depressive symptoms, although amitriptyline was more efficacious than citalopram in reducing migraine and TTH attacks. Patients who did not respond to monotherapy (<30% of improvement in the clinical scores) were treated with a combination of the two drugs for 16 additional weeks. In these selected patients, the combined treatment produced a substantial improvement in depression, migraine and TTH without producing major side effects such as those commonly related to the ‘serotonergic’ syndrome. The results indicate that a combined therapy with amitriptyline and citalopram may be particularly beneficial for patients with TTH, migraine and comorbid depression that do not respond to monotherapy.