Tension-type Headache Patients Research Articles

Effects of Dry Needling on Active Myofascial Trigger Points and Pain Intensity in Tension-Type Headache: A Randomized Controlled Study.

Tension-type headache is the most prevalent type of headache and is commonly associated with myofascial pain syndrome and the presence of active myofascial trigger points. This randomized controlled trial aimed to assess the impact of dry needling on the total number of active trigger points, pain intensity, and perceived clinical change in tension-type headache subjects. Thirty-two subjects were randomly assigned to the control and dry needling groups. The presence of active trigger points in 15 head and neck muscles, the headache intensity, and the perceived clinical change were evaluated. A single dry needling technique was administered at each active trigger point across three sessions. Significant differences were observed in the post-treatment measures favouring the dry needling group, including reductions in the headache intensity scores (p = 0.034) and the total number of active trigger points (p = 0.039). Moreover, significant differences in the perception of clinical change were found between the control and treatment groups (p = 0.000). Dry needling demonstrated positive effects in reducing the number of active trigger points and improving the short-term headache intensity in tension-type headache patients. A single dry needling session applied in the cranio-cervical area resulted in a self-perceived improvement compared to the control subjects.

Cervical impairments in subjects with migraine or tension type headache: an observational study.

The aim of this investigation was to compare the thickness of the deep local muscles in the neck region, as well as local and widespread sensitivity and functionality, between individuals with migraine, Tension-Type Headache (TTH), and healthy controls. To date, we know that the onset of migraine and TTH share similar pathophysiological pathways. Nevertheless, there may be some anatomical and functional differences which would explain why clinicians may obtain variable results when treating both pathological entities with similar or equal approaches. An observational study was conducted in accordance with STROBE guidelines. The flexor longus colli and multifidus, two neck-stabilizing muscles, were measured using B-mode ultrasound imaging. The upper trapezius, masseter, temporalis, tibialis anterior, and median nerve all underwent bilateral pressure-pain threshold (PPT) assessments. Ninety participants were enrolled in the study. All subjects were equally divided into TTH, migraine and control groups. The PPT values exhibited lower thresholds in patients with TTH than both migraine and healthy participants. Specifically, in the temporal muscle on both sides, patients with TTH exhibited a significantly lower threshold (p < 0.001)than both migraine and healthy participants. Patients with TTH displayed significantly lower thresholds in both upper trapezius muscles (right: p < 0.001; left: p = 0.001). Similar results were obtained for the tibialis anterior PPTs from both sides (p = 0.001 in both). However, both clinical groups exhibited lower thresholds than the healthy subjects (p < 0.001). In multifidus muscle cross-sectional area (CSA), no statistically significant differences were found between migraine patients and healthy subjects, both in relaxation and contraction (right; p > 0.05 and p > 0.05; left: p > 0.05 and p > 0.05). However, patients with TTH exhibited a smaller CSA than both migraine patients and healthy controls in multifidus relaxed and contracted state (right: p < 0.001 in both relaxed and contracted multifidus; left: p = 0.001 and p < 0.001, respectively). Similar results were obtained for the left longus colli muscle in both relaxation and contraction for patients with TTH and migraine compared with healthy subjects (p = 0.001 and p < 0.001, respectively, for muscle relaxation and p < 0.001 for muscle contraction). However, no significant differences were observed between patients with TTH and migraine (p < 0.05 in both relaxation and contraction). In the right longus colli, TTH and migraine patients had a significantly smaller CSA during contraction than healthy subjects (p < 0.001 in both comparisons). In the craniocervical flexion test, both groups of patients with TTH and migraine showed significantly lower values than healthy subjects (p < 0.001 in both comparisons). However, no significant differences were found between patients with TTH and migraineurs (p > 0.05). The findings provide a significant message for clinicians since anatomical and functional impairments were shown in patients with TTH and migraine. This study corroborates a lack of strength and smaller CSA in both clinical groups compared to controls. Therefore, strengthening programs may be addressed successfully for people with these pathological entities. To be more accurate, according to PPTs and CSA lower values in patients with TTH compared to migraine and controls, manual therapy approaches to desensitize craniocervical soft tissues and exercise therapy to increase endurance of deep cervical muscles may become meaningful especially in subjects with TTH. Nevertheless, in order to distinguish precisely between patients with TTH and migraine, different diagnostic strategies may be used in the future to describe these populations in further detail, which will assist health professionals in a more accurate treatment selection.

The Effect of Alpha Binaural Beats Auditory Stimulation on Quantitative Electroencephalography (QEEG) and Pain Intensity among Tension-Type Headache Patients

Tension-type headaches, the most prevalent primary headaches affecting 2-5% of the population, significantly impact sufferers' well-being. These headaches present a persistent health challenge, constituting a considerable portion of neurologist outpatient visits. Effectively managing tension-type headaches remains challenging and can lead to notable morbidity if untreated. Treatment typically involves prophylactic pharmacological therapy alongside non-pharmacological interventions. Among non-medication therapies, brainwave entrainment using binaural beats emerges as a promising option for chronic headaches. This experimental research employed a pre-test and post-test design over a 5-day period (30 minutes daily) to assess Alpha Binaural Beats Auditory stimulation's impact on the QEEG pattern and pain intensity reduction in tension-type headache patients. The study, involving 32 participants, revealed a statistically significant increase in relative alpha wave power (p-value of 0.000) and a significant decrease in relative beta wave power (p-value of 0.045) after exposure to alpha binaural beats. Additionally, the Numerical Rating Scale (NRS) recorded a statistically significant decrease in pain intensity (p-value of 0.000). These findings suggest that Alpha binaural beats contribute to increased alpha wave activity, decreased beta wave activity in the QEEG pattern, and a substantial reduction in pain intensity associated with tension-type headaches. However, further research is needed to explore cumulative effects and long-term sustainability in tension-type headache patients, advancing our understanding and application of this therapy.

Presence of Spontaneous Nystagmus, Benign Paroxysmal Positional Vertigo, and Tumarkin Fall in Patients With Primary Headache and Their Responses to Caloric and Video Head Impulse Tests.

Migraine, vestibular migraine (VM) and tension-type headache (TTH) are the most common disorders in dizziness and headache clinics, associated with dizziness or vertigo and postural imbalance, causing a substantial burden on the individual and the society. The objective of this research was to examine the presence of spontaneous nystagmus, comorbidity of benign paroxysmal positional vertigo (BPPV), and Tumarkin fall in patients; additionally, the study focused on assessing the patients' responses to bithermal caloric irrigation and video head impulse test (vHIT). Consecutive patients diagnosed with migraine, VM, and TTH according to the International Classification of Headache Disorders, third edition (beta version (ICHD-3β)), who were referred to Dizziness and Headache Clinic were enrolled. BPPV and Tumarkin fall were assessed by questionnaires. The presence of BPPV was further evaluated through Dix-Hallpike or head roll maneuver, while spontaneous nystagmus was monitored using video-oculography during interictal period. Lastly, patients' responses to bithermal caloric irrigation and vHIT were analyzed. There was a significantly higher incidence of spontaneous nystagmus in VM compared to both migraine and TTH. The drop attack episodes were slightly more frequent in VM than in TTH and migraine, though not statistically significant. The prevalence of BPPV was significantly higher in VM than in migraine and TTH. Unilateral vestibular paresis was more common in the VM group than in migraine and TTH. There was profound unilateral weakness (UW) in VM patients than in migraine, but no significant difference was found between VM and TTH. In VM, the percentage of saccades along with reduced vHIT gain was significantly higher than in migraine. Lastly, the percentage of abnormal response in vHIT was significantly lower than the percentage of abnormal UW in caloric irrigation across all groups. In VM patients, the prevalences of decompensated peripheral damage and BPPV were higher than in migraine and TTH patients as disclosed by the presence of peripheral spontaneous nystagmus and abnormal vHIT during the interictal period. Our findings suggest that the peripheral vestibular system acts as a significant mechanism in the pathogenesis of VM, and it might also be involved in migraine and TTH cases without vertigo symptoms.

The curative effect of fire needling combined with filiform needling on tension-type headache and its effect on the tenderness of pericranial muscles.

To observe the curative effect of fire needling pricking pericranial tender points combined with filiform needling on tension-type headache (TTH) and its effect on pericranial muscle tenderness, and explore the correlation between changes of headache symptoms and pericranial muscle tenderness in TTH, to analyze the influence of pericranial muscle tenderness on TTH. A total of 41 TTH patients in the treatment group and 38 TTH patients in the control group completed the study. The patients in the treatment group were treated with fire needling at pericranial tender points combined with filiform needling at Baihui (GV20), Sishencong (EX-HN1), Shenting (GV24), Touwei (ST8) and Fengchi (GB20). The patients in the control group were only treated with the same filiform needling as the treatment group. Patients in the two groups were treated twice a week for 8 weeks. Before and after treatment, the days of headache onset, the number and distribution of pericranial muscle tender points were recorded, the degree of headache was evaluated by visual analogue scale and the threshold of pericranial muscle tender points were measured. The correlations between the changes of the days and degree of headache onset and the changes of the number and threshold of pericranial muscle tender points were analyzed. The effective rates in the two groups were calculated. Compared with those before treatment, the days of headache onset and the degree of headache were decreased (P<0.05) in the two groups；the number of pericranial muscle tender points was decreased (P<0.05) and the tenderness threshold was increased (P<0.05) in the treatment group. After treatment, compared with the control group, the days of headache onset, the degree of headache, and the number of pericranial muscle tender points were decreased (P<0.05), and the tenderness threshold was increased (P<0.05) in the treatment group. The decrease of the days and degree of headache was positively correlated with the decrease of number and the increase of tenderness threshold of pericranial muscle tender points (P<0.05). The effective rate in the treatment group was 87.80% (36/41), which was higher than 57.89% (22/38) in the control group (P<0.05). The most common anatomic location of tender points in baseline was superior trapezius muscle, followed by sternocleidomastoid muscle, superior nuchal line, temporal muscle, masseter muscle, etc. The fire needling at the pericranial muscle tender points combined with filiform needling on TTH patients can significantly improve the clinical symptoms and reduce the pericranial muscle tenderness. The pericranial muscle tenderness is an important factor in the pathogenesis of TTH.

Imaging Correlates between Headache and Breast Cancer: An [18F]FDG PET Study.

This study aimed to examine brain metabolic patterns on [18F]Fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) in breast cancer (BC), comparing patients with tension-type headache (TTH), migraine (MiG), and those without headache. Further association with BC response to neoadjuvant chemotherapy (NAC) was explored. In this prospective study, BC patients eligible for NAC performed total-body [18F]FDG PET/CT with a dedicated brain scan. A voxel-wise analysis (two-sample t-test) and a multiple regression model were used to compare brain metabolic patterns among TTH, MiG, and no-headache patients and to correlate them with clinical covariates. A single-subject analysis compared each patient's brain uptake before and after NAC with a healthy control group. Primary headache was diagnosed in 39/46 of BC patients (39% TTH and 46% MiG). TTH patients exhibited hypometabolism in specific brain regions before NAC. TTH patients with a pathological complete response (pCR) to NAC showed hypermetabolic brain regions in the anterior medial frontal cortex. The correlation between tumor uptake and brain metabolism varied before and after NAC, suggesting an inverse relationship. Additionally, the single-subject analysis revealed that hypometabolic brain regions were not present after NAC. Primary headache, especially MiG, was associated with a better response to NAC. These findings suggest complex interactions between BC, headache, and hormonal status, warranting further investigation in larger prospective cohorts.

Inflammatory and infectious parameters in tension-type headache

Although tension-type headache (TTH) is the most common primary headache in the world, much fewer studies on its pathophysiology have been carried out in comparison to other primary headaches. Inflammatory processes are important in the pathophysiology of both peripheral and central pain. Studies on the role of inflammatory markers in TTH patients are limited. Therefore, in this study, it was aimed to examine the role of inflammatory parameters in TTH. 199 TTH patients and 154 control participants were involved in this study. C-reactive protein (CRP) and high-density lipoprotein (HDL) levels and neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), monocyte/lymphocyte (MLR), HDL/monocyte and Immature/Total granulocyte ratios in all patients reviewed retrospectively. CRP value and immature/total granulocyte ratio were found to be significantly higher in the patient group when compared to the control group. No difference was found between NLR, PLR, MLR, and HDL/Monocyte ratios. There was no difference in NLR, MLR, immature/mature granulocyte ratios, and CRP values between the genders in the patient group. Median values of PLR, HDL, and HDL / monocyte were found to be higher in males. The fact that there is no difference in most of the inflammatory parameters in TTH and there is a significant difference in the immature/total granulocyte ratio is a new finding on this subject. There is no other study in the literature examining the immature/total granulocyte ratio in headaches.

Disease burden of migraine and tension-type headache in non-high-income East and Southeast Asia from 1990 to 2019

BackgroundThe world faces severe challenges from migraine and tension-type headache (TTH), which cause grave disability to patients and place a heavy burden on their caregivers. However, headaches in specific individual regions have rarely been investigated. Therefore, we aimed to fully analyse and describe the current status and changing trends in migraine and TTH in non-high-income East and Southeast Asia to provide more detailed real-world information for policy-making.MethodsThe migraine and TTH data used for analysis were all extracted from the Global Burden of Disease (GBD) database. We adopted three major indicators of disease burden, including prevalence, incidence, and years lived with disability (YLD), and two major metrics, including the absolute number and the age-standardized rate, in our present study for further evaluation by age and sex. The results are presented in the form of mean values and 95% uncertainty intervals (UIs). In addition, the differences between non-high-income East and Southeast Asia and other regions, as well as the potential associations between headache burden and socioeconomic background, were explored.ResultsIn 2019, approximately 195,702,169 migraine patients and 291,924,564 TTH patients lived in non-high-income East Asia, and 113,401,792 migraine patients and 179,938,449 TTH patients lived in non-high-income Southeast Asia. In terms of specific countries and regions, the highest age-standardized YLD rate (ASYR) of migraine was in Thailand [645 (95% UI: 64 to 1,554)]. The highest ASYR of TTH was in Indonesia [54 (95% UI: 15 to 197)]. Furthermore, people between the ages of 40 and 44, especially females, were identified as the main population that suffered from migraine and TTH. Unfortunately, we did not observe a significant association between headache burden and socioeconomic background.ConclusionsTo date, the threats from migraine and TTH in non-high-income East and Southeast Asia are still serious and ongoing, leading to prominently negative impacts on the daily life and work of local residents. Therefore, full attention and sound guidelines are urgently needed to obtain greater advantages in fighting against the burden of headache disorders in the future.

A Computer Vision-Based Application for the Assessment of Head Posture: A Validation and Reliability Study

As its name implies, the forward head position (FHP) is when the head is further forward of the trunk than normal. This can cause neck and shoulder tension, as well as headaches. The craniovertebral angle (CVA) measured with 2D systems such as Kinovea software is often used to assess the FHP. Computer vision applications have proven to be reliable in different areas of daily life. The aim of this study is to analyze the test-retest and inter-rater reliability and the concurrent validity of a smartphone application based on computer vision for the measurement of the CVA. Methods: The CVAs of fourteen healthy volunteers, fourteen neck pain patients, and fourteen tension-type headache patients were assessed. The assessment was carried out twice, with a week of rest between sessions. Each examiner took a lateral photo in a standing position with the smartphone app based on computer vision. The test-retest reliability was calculated with the assessment of the CVA measured by the smartphone application, and the inter-rater reliability was also calculated. A third examiner assessed the CVA using 2D Kinovea software to calculate its concurrent validity. Results: The CVA in healthy volunteers was 54.65 (7.00); in patients with neck pain, 57.67 (5.72); and in patients with tension-type headaches, 54.63 (6.48). The test-retest reliability was excellent, showing an Intraclass Correlation Coefficient (ICC) of 0.92 (0.86–0.95) for the whole sample. The inter-rater reliability was excellent, with an ICC of 0.91 (0.84–0.95) for the whole sample. The standard error of the measurement with the app was stated as 1.83°, and the minimum detectable change was stated as 5.07°. The concurrent validity was high: r = 0.94, p &lt; 0.001. Conclusion: The computer-based smartphone app showed excellent test-retest and inter-rater reliability and strong concurrent validity compared to Kinovea software for the measurement of CVA.

Vajinismusta başağrısı, anksiyete ve depresyon

Abstract&#x0D; Objective: Vaginismus is one of the most common problems among patients who apply to the sexual health outpatient clinic. It is known that sexual problems are more common in migraine and tension-type headache patients. Furthermore, the frequency of depression and anxiety is higher in both vaginismus and chronic headache patients. This study was conducted in 2021 and examined the headache characteristics, depression and anxiety in vaginismus patients.&#x0D; Material and methods: In this prospective study, 87 patients diagnosed with vaginismus in the sexual health outpatient clinic were interviewed. Fifty patients who agreed to participate in the study were questioned regarding headache, and Beck depression and Beck anxiety scales were applied.&#x0D; Results: Headache was present in 46% (n:23) of 50 vaginismus patients. Anxiety scores of patients with headaches were higher than those without headaches (p=0.032). The most common type of headache was migraine without aura (60.9%), followed by tension-type headache (30.4%). Beck depression scores of the low-income group were higher than the high-income group (p=0.006). There was no significant correlation between monthly headache frequency, total headache duration, Beck depression score, and Beck anxiety score.&#x0D; Conclusions: Headache is a common neurological symptom in vaginismus patients, and the frequency of migraine is higher than tension-type headaches. Anxiety values are higher in vaginismus patients experiencing a headache. Therefore, headache and anxiety should be considered in the follow-up and treatment of vaginismus patients.

The effectiveness of botulinum toxin for chronic tension-type headache prophylaxis: A systematic review and meta-analysis.

A systematic and meta-analysis was conducted to examine the evidence of the effects of botulinum toxin A on chronic tension-type headache. Cochrane, Embase, Ovid, ProQuest, PubMed, Scopus, Web-of-Science databases, and ClinicallTrials.gov registry were systematically searched for studies examining the effects of botulinum toxin A on tension-type headaches. The records were screened by two independent reviewers using pre-determined eligibility criteria. DerSimonian Liard random-effects meta-analyses were performed using the 'meta' package (5.2-0) in R (4.2.0). Risk of bias and quality of evidence were assessed using the Cochrane Collaboration's Tool RoB 2 and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Clinical significance was determined using pre-defined minimal clinically important differences. Eleven controlled trials were included (390 botulinum toxin A, 297 controls). Botulinum toxin A was associated with significant improvements in standardized headache intensity (-0.502 standard deviations [-0.945, -0.058]), headache frequency (-2.830 days/month [-4.082, -1.578]), daily headache duration (-0.965 [-1.860, -0.069]) and the frequency of acute pain medication use (-2.200 days/month [-3.485, -0.915]) vs controls. Botulinum toxin A-associated improvements exceeded minimal clinically important differences for headache intensity, frequency, and acute pain medication use. A 79% (28%, 150%) greater response rate was observed for botulinum toxin A vs controls in improving chronic tension-type headache. Treatment of eight chronic tension-type headache patients was sufficient to elicit a therapeutic response in one patient. Corroborating the current mechanistic evidence, our meta-analysis supports the utility of botulinum toxin A for managing chronic tension-type headaches. However, due to limitations in the quality of evidence, adequately-powered high-quality controlled trials examining the effects of Botulinum toxin A on chronic tension-type headache are warranted. Protocol preregistered in PROSPERO International Prospective Register of Systematic Reviews (CRD42020178616).

Status of Thyroid Hormones among Chronic Tension Type Headache Patients

Background: Tension-type headache is frequently reported by the patients.&#x0D; Objective: The purpose of the present study was to see the status of thyroid hormones among chronic tension type headache patients.&#x0D; Methodology: This study was conducted in the Department of Neurology at Dhaka Medical College, Dhaka, Bangladesh. The study subjects consisted of patients presented with primary headache disorders.&#x0D; Result: Among the patients 21.0% had chronic sub-type of TTH. Out of 42 chronic tension-type headache patients 12 had subclinical and another 12 had overt hypothyroidism. Statistically significant difference was seen among different sub-types of headache in relation to thyroid status.&#x0D; Conclusion: Hypothyroidism is found to be a co morbidity or precipitating factors to be development of chronic type of tension-type headache.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):189-192

Efficacy of Kampo medicine Kakkonto as acute medication to treat tension-type headache among musculoskeletal pain patients using regular analgesics.

Tension-type headache (TTH) is the most prevalent type of primary headache disorder. Its acute pharmacotherapy is acetaminophen or non-steroidal anti-inflammatory drugs based on the Japanese Clinical Practice Guideline for Headache Disorders 2021. With Japan's aging population, however, the number of TTH patients with comorbidities that have been treated by analgesics is increasing. Under this context, it is sometimes difficult to select an acute pharmacotherapy for TTH. Kakkonto, Japanese traditional herbal kampo medicine, is empirically used for TTH. We hypothesized that kakkonto has efficacy for TTH with painful comorbidities. We prospectively collected 10 consecutive TTH patients who had already taken analgesics for comorbidities. We prescribed 2.5g of kakkonto (TJ-1), and patients took it. A numerical rating scale for pain before and 2 hours after kakkonto intake was evaluated. Eight women and 2 men were included. The mean age was 71.0 ± 13.4 years old. Four patients had lower back pain, 2 had lumbar spinal stenosis, 2 had knee pain, 1 had neck pain, and 1 had shoulder myofasciitis. Celecoxib was used for 4 patients, acetaminophen for 3, loxoprofen for 2, and a combination of tramadol and acetaminophen for 1, as routinely used analgesics. The median numerical rating scale statistically improved from the median of 4 to that of 0. There were no side effects of kakkonto. Kakkonto showed efficacy as an acute medication for TTH with comorbidities that have been treated by analgesic.

Effect of slow breathing exercise on heart rate variability in tension-type headache female patients: A time domain analysis

Background: Tension-type headache (TTH), the most frequently occurring primary headache is associated with autonomic dysfunction. Time domain analysis of heart rate variability (HRV) is a popular tool to detect changes in cardiac autonomic nerve function (CANF) in TTH patients. Slow breathing exercise (SBE) can significantly improve HRV in patients with cardiovascular disorders. Objective: To observe the effect of SBE on HRV by time domain analysis in TTH female patients. Methods: This quasi-experimental study was conducted from March 2021 to February 2022 in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka on 60 female TTH patients aged 20-45 years. Thirty patients performed SBE every morning and evening for 30 minutes in addition to receiving conventional treatment and 30 patients continued only conventional treatment without any exercise for 90 days. Thirty age, sex and BMI matched apparently healthy control were enrolled who did not perform SBE or any other exercise. All subjects were assessed at baseline and also after 90 days. Time domain HRV parameters were recorded by Power Lab 8/35 AD Instruments, Australia. One way ANOVA followed by post-hoc test and Paired sample t-test were performed for statistical analysis and p&lt;0.05 was considered as statistical significance. Results: Mean heart rate (HR) was significantly higher (p&lt;0.001) and SDRR (Standard deviation of all RR interval); CVRR (Coefficient variation of RR interval); SDSD (Standard deviation of successive RR interval differences between adjacent RR intervals); RMSSD (Square root of mean of squared differences of successive RR interval) and pRR50% (Proportion of RR interval with duration &gt; 50ms) were significantly lower (p&lt;0.001) in TTH female patients compared to control at baseline. Significant decrement of mean HR (p&lt;0.001) and increment of all other time domain parameters (p&lt;0.001) was observed after 90 days of SBE. Again, significantly decreased SDRR, CVRR, SDSD, RMSSD and pRR50% (p&lt;0.001, p&lt;0.01) was observed in the patients who did not perform SBE. Conclusion: SBE may effectively improve cardiac autonomic dysfunction in TTH female patients. J Bangladesh Soc Physiol. 2022, June; 17(1): 56-63

Triggers and clinical changes of childhood primary headache characteristics during COVID-19 pandemic lockdown.

Children with primary headache are particularly vulnerable to the negative impacts of the pandemic due to factors like increased social isolation, disruption of sleep and impairment of healthy diet. We aimed to investigate the clinical changes and triggering factors for childhood primary headaches to demonstrate the impact of the pandemic lockdown. Children aged between 60months and 18years with headache complaint attending the general outpatient clinic between December 2019 and December 2020 were included in the study. Patients were classified according to ICHD-3 regarding clinical and laboratory data. Primary headaches diagnosed before (December 2019-March 2020) and during the pandemic lockdown (April 2020-December 2020) were divided into two groups as migraine and tension-type headache (TTH). Clinical picture and triggering factors were compared between groups to illustrate the effect of the lockdown. The study included 612 subjects, with 463 patients (76%) classified in the primary headache group and 149 (24%) in the secondary headache group. Among the first group, 267 patients (58%) had migraine and 196 patients (42%) had TTH. Comparisons between before and during the pandemic lockdown showed significant increased frequency of TTH, but no difference in the frequency and duration of migraine. Both screen exposure and sleep pattern changes were found to be significantly increased in the TTH group during the pandemic lockdown. We found a significant increase in the attack frequency for TTH patients during the pandemic lockdown. Reduction in screen time is an important strategy in preventing primary headache attacks in children.

Illness perception and quality of life in patients with migraine and tension-type headache

ABSTRACT Introduction Migraine and tension-type headache (TTH) are important health problems because cause loss of workforce, affect quality of life and are frequently associated with anxiety and depression. Illness perception is defined as a cognitive aspect of illness. The aim of this study is to determinethe relationship of migraine and TTH with quality of life, illness perception, anxiety and depression. Materials and Methods Demographic information and headache characteristics of 160 patients (80 migraine, 80 TTH) who has applied to our hospital’s neurology outpatient clinics were recorded. Hospital anxiety depression scale, illness perception questionnaire and quality of life short form-36 (SF-36) were applied to these patients. Results Headache severity and duration were higher in migraine patients. Migraine sufferers believed that their illness would last longer and the results would be worse. Negative emotional representations were more common in TTH patients. Understanding of the disease was higher in younger and those with higher levels of education. Social functionality and bodily pain scores were worse than those of TTH patients. Headache severity and duration were higher in women. Anxiety and depression were associated with headache frequency, duration, and severity. It was determined that the severity, duration and frequency of headache also affected the quality of life. Conclusion Informing patients in detail about their diseases and increasing their education level can contribute to the improvement of headache representations. In addition, screening and treatment of anxiety and depression may be other interventions that can improve patients’ adherence to treatment and quality of life.

Tension-type headache and hypertension phenotype: Myth or reality

Objective. This review article provides an analysis of studies focusing on the problem of comorbid tension-type headache (TTH) and hypertension (HT).Key Points. A combination of headache and HT is common in clinical practice. The analysis of studies showed that 53.7% of hypertensive patients present with complaints of headache, and 30.7% of headache patients have HT in the anamnesis. The prevalence of HT is 1.9 times higher in TTH patients than in those with migraine. The results demonstrate the presence of two separate, but highly comorbid nosologies (HT and TTH) among study participants included in the review. Evaluation of research methodology showed that the discrepancies in the results may be explained by the differences in design and sample characteristics (degree and profi le of HT; duration of HT and TTH). Patients with mild HT do not have direct associations between headache and increased blood pressure. Blood pressure values do not diff er during, before, and after TTH paroxysm. HT is less prevalent in patients with episodic TTH compared with that in patients with chronic TTH.Conclusion. The analysis of available studies suggests that TTH + HT phenotype is a frequent condition, but its real prevalence rates require further studies.

Examining the correlation between salivary cytokine concentrations and CRP in people experiencing social-cognitive stress

ABSTRACT Objectives The study aims to determine the relationship of migraine and chronic tension-type headache (TTHs) with alterations in the salivary markers of inflammation . - Methods The prospective study involved 75 patients . The concentrations of inflammatory markers (CRP, IL-1 β, and IL-6) in migraine and chronic TTH patients were determined in distinct time points: headache-free period (interictal period), during headache (ictal period), day after headache attack. The STAI-Y (State Trait Anxiety Inventory – Y) and BDI (Beck Depression Inventory) questionnaires were used to measure the level of anxiety and depression in the interictal and ictal periods. Results The interictal levels of CRP, IL1-β, and IL-6 were significantly higher in headache groups compared to healthy controls (p < 0.001). Differences in the ictal concentrations were even stronger. Twenty-four hours after headache attack, patients with migraine and chronic TTH experienced a decrease in CRP, IL1-β, and IL-6 levels; yet, those levels were still higher compared with the interictal ones. The repeated analysis of variance revealed no significant statistical differences in CRP, IL-β, and IL-6 levels between the migraine and TTH groups over time (p > 0.05). Statistically higher levels of anxiety and depression were seen in unhealthy groups (p < 0.01). Conclusions The relationship of CRP, IL1-β, and IL-6 concentrations with migraine and chronic TTH has been established. No statistically significant differences were found in the dynamics between migraine and chronic TTH groups. There was a direct correlation of migraine and chronic TTH with anxiety and depression.

Comparison of Genders in the Effectiveness of AcupunctureTherapy in Tension-TypeHeadache

Objective: Tension-type headache (TTH) with an average lifetime prevalence of 46% (12-78%) in adults is the most common primary headache type. Acupuncture treatment is one of the adjunctive therapy in tension type headache so we wanted to evaluate the response difference of acupuncture between genders.&#x0D; Material and Methods: In this retrospective study, the medical records of TTH patients, aged between 18 and 60, who did not receive conventional medical treatment (patient refusing medical treatment or intolerance due to drug side effects) and completed pre-determined sessions of acupuncture therapy in the outpatient clinics between 2017 and 2019 were evaluated. The monthly attack frequency, attack severity (Visual Analogue Scale), and the duration of attacks before and after acupuncture treatment between genders were documented.&#x0D; Results: A total of 17 patients meeting the study criteria were included in the study. No statistically significant difference in the frequency, the duration, and the severity of monthly attacks before and after the treatment were found between the genders. The monthly attack frequency and Visual Analogue Scale (VAS) score were found to be significantly decreased in women themselves before and after treatment in themselves. There was no statistically significant difference in the frequency, duration and severity of monthly attacks before and after the treatment among the men.&#x0D; Conclusion: Acupuncture should be considered as an alternative treatment option, especially in women with chronic TTH who do not want to use drugs or who have tolerability problems due to side effects or combination with medical therapy.

The impact of the COVID-19 pandemic on patients with tension-type headache: A multicenter survey

Background &amp; Objective: Tension-type headache (TTH) is the most common primary headache. TTH worsens quality of life and is related to various psychosocial factors. We aimed to examine the severity of headache (intensity, frequency, and duration), analgesic use, quality of life (QoL), and the impact of COVID pandemic-induced stress in TTH patients. Methods: TTH cases seen at neurology outpatient clinics in 15 centers in Turkey were included in the study. A questionnaire incorporating sociodemographic and medical information, headache features, sleep quality, general quality of life, and impact of the pandemic event was administered to the subjects. Results: A total of 975 TTH patients were evaluated. Headache severity was higher in women as well as in patients with a history of COVID-19 contact. Women, those with chronic diseases, and cases with a COVID-19 contact history had worse perceptions of quality of life and were affected to a greater extent by the pandemic. The factors affecting the impact of the pandemic were female gender and difficulty in access to health services for headache. Co-existing chronic diseases and lost productive time due to headaches were negative determinants for both QoL and the impact of the pandemic. Conclusion: Our results show that the COVID pandemic severely worsened the headache burden, quality of life and mental health of TTH patients. These findings can guide us in the clinical approach to TTH cases.