Treatment Of Tension Headache Research Articles

TREATMENT OF TENSION HEADACHE, ASSOCIATED WITH TRIGGER POINTS

TREATMENT OF TENSION HEADACHE, ASSOCIATED WITH TRIGGER POINTS

Neurobiological mechanisms of transcranial magnetic stimulation and its comparative efficacy in tension headache and migraine

Transcranial magnetic stimulation (TMS) is one of the nonpharmacological methods to affect the central nervous system. This approach allows a noninvasive stimulation of the cerebral cortex. The method is based on the ability of magnetic fields to penetrate the bone and muscle structures. The induced magnetic field depolarizes the neuronal membrane, and the generated action potential propagates through the conducting pathways. In the review, the biophysical effects of TMS, as well as its neural, immune, mediator and macro effects are analyzed. The main contraindications to TMS and its side effects are considered. Nonpharmacological treatment of tension headache (TH) and migraine is a promising direction, since the incidence of these types of primary headaches reaches 40-65 and 11-22%, respectively. In the article the current state of study of various modes and durations of TMS procedure, and the site of exposure in TH and migraine are considered. In recent years there is noted an increase in the number of evidence-based randomized, placebo-controlled studies on the effectiveness of TMS in migraine therapy. Much attention is given to evaluation of the effect of TMS in migraine. There is much evidence of the positive effect of this procedure. However, the amount of examined volunteers does not provide the highest level of evidence. Experiments on animals and use of functional neurovisualization techniques contribute to understanding of the mechanisms of TMS effect. Active participation of physiologists, neurophysiologists and biophysicists in these research works will permit evaluation of the effectiveness of TMS in nonpharmacological treatment of patients with pain syndrome. This approach will improve the working capacity and quality of life in TH and migraine.

Neurobiological mechanisms of transcranial magnetic stimulation and its comparative efficacy in tension headache and migraine

Transcranial magnetic stimulation (TMS) is one of the nonpharmacological methods to affect the central nervous system. This approach allows a noninvasive stimulation of the cerebral cortex. The method is based on the ability of magnetic fields to penetrate the bone and muscle structures. The induced magnetic field depolarizes the neuronal membrane, and the generated action potential propagates through the conducting pathways. In the review, the biophysical effects of TMS, as well as its neural, immune, mediator and macro effects are analyzed. The main contraindications to TMS and its side effects are considered. Nonpharmacological treatment of tension headache (TH) and migraine is a promising direction, since the incidence of these types of primary headaches reaches 40-65 and 11-22%, respectively. In the article the current state of study of various modes and durations of TMS procedure, and the site of exposure in TH and migraine are considered. In recent years there is noted an increase in the number of evidence-based randomized, placebo-controlled studies on the effectiveness of TMS in migraine therapy. Much attention is given to evaluation of the effect of TMS in migraine. There is much evidence of the positive effect of this procedure. However, the amount of examined volunteers does not provide the highest level of evidence. Experiments on animals and use of functional neurovisualization techniques contribute to understanding of the mechanisms of TMS effect. Active participation of physiologists, neurophysiologists and biophysicists in these research works will permit evaluation of the effectiveness of TMS in nonpharmacological treatment of patients with pain syndrome. This approach will improve the working capacity and quality of life in TH and migraine.

A Comparison of Efficacy and Safety of Non-steroidal Anti-inflammatory Drugs versus Acetaminophen in the Treatment of Episodic Tension-type Headache: A Meta-analysis of Randomized Placebo-controlled Trial Studies

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are widely used in the treatment of tension headache. The objective of this study was to evaluate and compare the efficacy and safety of single doses of acetaminophen and NSAIDs using meta-analysis of randomized placebo-controlled trial studies.MethodsWe searched MEDLINE, EMBASE, CINAHL, Cochrane, KMbase, KoreaMed, RiCH, National Assembly Library, Riss4u, and DBPIA for studies released through 27th July 2010. Two authors independently extracted the data. To assess the risk of bias, the Cochrane Collaborations risk of bias tool was used. Review Manager 5.0 was used for statistics.ResultsWe identified 6 studies. The relative benefit of the NSAIDs group compared to the acetaminophen group for participants with at least 50% pain relief was 1.18 (95% confidence interval [CI], 0.99 to 1.39; I2 = 85%). We did subgroup analysis based on allocation concealment versus non-allocation concealment, and low-dose NSAIDs versus high-dose NSAIDs. The relative benefit of the low-dose NSAIDs subgroup to the acetaminophen group was 0.98 (95% CI, 0.91 to 1.06; I2 = 0%). However, the heterogeneity of other subgroup analysis was not settled. The relative risk for using rescue medication of the NSAIDs group compared to the acetaminophen group was 0.84 (95% CI, 0.64 to 1.12; I2 = 47%). The relative risk for adverse events was 1.31(95% CI, 0.96 to 1.80; I2 = 0%).ConclusionIn this meta-analysis, there was no difference between low-dose NSAIDs and acetaminophen in the efficacy of the treatment for tension type headache. The results suggested that high-dose NSAIDs have more effect but also have more adverse events. The balance of benefit and harm needs to be considered when using high-dose NSAIDs for tension headache.

P02-365 - The effectiveness of cognitive behavioral therapy on reduction of chronic tension headache

ObjectivesThe International Headache Society (IHS) defined chronic tension type headache (CTTH) in adult patients as attacks of headache that occur on at least 15 days per month over a period of at least 6 months. CTTH is costly to individual sufferers, through pain and reduced functioning, and to society, through decreased work productivity and increased health care use. Drugs do not adequately benefit many disabled headache sufferers. Behavioral headache treatments are rooted in the conceptualization of headache as a psychophysiological disorder. Such treatments target the patient's headache-related physiological responses (relaxation training, biofeedback) or behaviors, emotions, and cognitions (cognitive-behavioral therapy, stress-management). The aim of present research was examine the efficacy of cognitive-behavioral therapy for reduction of headaches in patient with chronic tension headache.MethodsThe method of this study was field/experimental. The target population of the study consisted of patient with CTTH that referred to psychiatric or neurology clinics in kashan. The sample consisted of 38 women with CTTH were assigned randomly to drug plus cognitive behavioral therapy (experimental, n=18) and drug alone (control, n=20) groups. Subjects were completed the headache diary for one week before and after intervention.ResultsAn analysis of covariance showed significant differences between experimental and control groups in variable of frequency, intensity and duration of headache attacks. Drug plus CBT was found to be more effective in reducing of headache than the drug therapy alone.ConclusionsDrug plus CBT is better than drug alone in treatment of tension headache.

The impact of a worksite migraine intervention program on work productivity, productivity costs, and non-workplace impairment among Spanish postal service employees from an employer perspective

SUMMARYBackground: Migraine is associated with a significant productivity loss to employers, who may benefit from making a migraine intervention available to their employees.Objective: To evaluate changes in migraine-related productivity and non-workplace impairment associated with a migraine intervention program from the employer perspective.Methods: This was a pre-test post-test study of Spanish Postal Service employees with migraine. The intervention consisted of counseling from occupational health physicians and rizatriptan 10 mg for symptomatic treatment of two subsequent migraine headaches. Physicians also prescribed additional medications for migraine prophylaxis, treatment of tension headaches, and rescue medications. Migraine-related work loss and non-workplace impairment (interference with daily and social activities) were self-reported at baseline (pre-intervention) and separately following each migraine headache (post-intervention) with the aid of a diary. Migraine-related work loss was reported as work loss due to absenteeism, reduced productivity while at work, and the sum of the two (total lost work day equivalents [LWDE]). An employer perspective was taken for the cost analysis, and thus productivity costs were the only costs considered.Results: A total of 436 patients comprised the population for analysis. The number of migraine-related LWDE per migraine attack were 0.48 days per migraine headache in the month before the intervention, decreasing to 0.20 days and 0.07 days per migraine headache during the first and second migraine headaches following the intervention ( p < 0.0001 vs. baseline). Total migraine-related productivity costs per migraine headache were €34/patient before the intervention, decreasing to €14/patient and €5/patient during the first and second headaches following the intervention ( p < 0.0001).Non-workplace activity impairment was also significantly reduced ( p < 0.0001) following the intervention. The main limitations of the study were the lack of a parallel control group and the potential for differential recall bias between the usual care and the intervention periods. In addition, the results may not be generalizable to other employers or other countries.Conclusion: This study documents the value of a workplace migraine intervention program, which focused on migraine prevention and rizatriptan-based symptomatic treatment. It also highlights the important role occupational health clinics can play in helping employers and employees reduce the burden of migraine.

Butalbital-containing agents: Should they be banned? no.

Butalbital compounds are of proven efficacy in the treatment of tension headache. Decades of experience have established their value in the treatment of other mild-to-moderate headaches. Untold numbers of people rely on these medications as their drug of choice or use them when vasoconstrictors, opioids, or nonsteroidal anti-inflammatory agents are contraindicated. The medications are cost-effective with only occasional and minor immediate adverse effects. Their overuse may cause the evolution of episodic primary headaches to chronic daily headaches; however, removal of these agents from the market would reduce the chronic daily headache in the general population by a small fraction of 1%.

Biofeedback in the treatment of headache and other childhood pain.

Since the first biofeedback (BFB) studies on pediatric pain were published in the early 1980s, most of the studies have focused on the treatment of pediatric migraine. More recently, BFB has also been evaluated in the treatment of tension headache in children. Not surprisingly, most of what we know about the efficacy and mechanisms of BFB in the treatment of children's pain problems concerns the treatment of childhood headache (HA). In this review, we provide a detailed summary of studies that have evaluated BFB in the treatment of childhood HAs with an emphasis on treatment outcome and maintenance of treatment success. Moreover, findings and hypotheses with regard to the mechanisms that may mediate the treatment effects of BFB are addressed. Finally, we discuss specific issues relating to the treatment of pain in children with BFB and outline future directions of research.

Propofol dependency after treatment of tension headache.

Propofol is a widely used general anaesthetic with growing usage outside anaesthesia. Despite its potential for abuse only five cases of propofol dependency have yet been reported. These comprise health care professionals with easy access to the drug. This is the first reported case of propofol dependency in a lay person. One should be aware of the abuse potential of propofol with regard to its growing use outside the context of general anaesthesia.

Botulinum toxin A for the treatment of headache disorders and pericranial pain syndromes

For 20 years botulinum toxin A has been used for the treatment of a variety of disorders characterised by pathologically increased muscle contraction. Recently, treatment of tension headache, migraine, cluster headache, and myofascial pain syndromes of neck, shoulder girdle, and back with botulinum toxin A has become a rapidly expanding new field of research. Several modes of action are discussed for these indications. The blockade of cholinergic innervation reduces muscular hyperactivity for 3 to 6 months. Degenerative changes in the musculoskeletal system of the head and neck are prevented. Nociceptive afferences and blood vessels of the pericranial muscles are decompressed and muscular trigger points and tender points are resolved. The normalisation of muscle spindle activity leads to a normalisation of muscle tone and central control mechanisms of muscle activity. Oromandibular dysfunction is eliminated and muscular stress removed. However, the effect of botulinum toxin A cannot be explained by muscular actions only. Its retrograde uptake into the central nervous system modulates the expression of substance P and enkephalins in the spinal cord and nucleus raphe. Recent findings suggest an inhibition of sterile inflammation which may lead to a blockade of the neurogenic inflammation believed to be the pathophysiological substrate of primary headache disorders. The efficacy of botulinum toxin A in the treatment of pain disorders is being investigated in several studies at the moment. The results and experiences obtained so far present new alternatives in the treatment of chronic pain disorders. The practical use of botulinum toxin A is demonstrated.

CAPILLARY ELECTROPHORESIS DETERMINATION OF BUTALBITAL FROM SERUM USING SOLID PHASE EXTRACTION (SPE) AND ULTRAVIOLET DETECTION

Butalbital is a sedative hypnotic that is used mainly in combination with analgesics in the treatment of tension headaches. This paper develops and validates a rapid and sensitive method for the determination of butalbital in serum using capillary electrophoresis (CE) and ultraviolet detection. The internal standard chosen for this assay was aprobarbital because it showed similar chemical structure, identical chromatographic/SPE characteristics, and was commercially available. The CE run buffer contained 50 mM sodium dihydrogen phosphate buffer at pH 9.0 containing 20 mM hydroxypropyl-β-cyclodextrin as a capillary zone electrophoresis (CZE) buffer additive. An SPE method, using C[18] Bond-Elut cartridges, was developed to recover the drug and internal standard from serum. The CE system consists of a 75 micron I.D., 52 cm length fused silica capillary maintained at a run voltage of 15 kV with sample detection performed at 254 nm. The limit of detection for butalbital was <l μg/mL from serum. Linear calibration curves generated in the concentration ranges of 1 to 60 μg/mL showed a coefficient of determination greater than 0.99. The precision and accuracy of the method calculated as RSD and error were 0.65–3.16% and 2.20–8.90%, respectively. Butalbital is commonly coadminisetred with aspirin, acetaminophen, caffeine, and codeine for the treatment of tension headaches. The CE method baseline resolved these compounds from the butalbital and the internal standard. Therefore, there is a decreased chance for interference from commonly coadministered compounds in this assay.

A Pilot Study of Acupuncture for Tension Headache, Using a Novel Placebo

Tension headache is common, and treatment with acupuncture is frequently recommended, although the evidence of its effectiveness is contradictory. This small, randomised, controlled trial was designed as a pilot to test procedures in preparation for a multi-centre trial investigating the effect of acupuncture as a treatment for tension headache. Ten volunteers suffering from episodic, tension-type headache were recruited by local newspaper articles. Patients were randomised to receive either brief needling to tender areas or selected traditional points (Group A), or pressure from a cocktail stick supported within a guide tube to defined, non-tender and non-acupuncture areas (Group B). The patients’ view of the treatment sites was obstructed so that no indication could be gained as to which form of treatment was being given. Throughout the period of the trial, duration, frequency and intensity of headaches were recorded, from which the mean weekly headache index was calculated. There was no difference between the changes in weekly headache index in the two groups, comparing scores before and after treatment. However, Group A experienced a considerably higher number of headache-free weeks than Group B. The credibility of the two procedures was tested using a standard credibility questionnaire and a “final verdict”. One subject in Group B concluded that she had not received genuine acupuncture, but overall there was no statistical difference between the credibility of treatment in the two groups.

Psychological Treatment of Tension Headaches in School Children

Psychological Treatment of Tension Headaches in School Children

Effect of Biofeedback Treatment on Sympathetic Function in Common Migraine and Tension-Type Headache

Behavioral therapies such as biofeedback are commonly used to treat migraine and tension headache. Controlling sympathetic activity is effective for controlling the pain in both disturbances. A group of 26 common migraine patients and a group of 14 tension headache patients were treated by electromyographic biofeedback (EMG-BFB); blood samples were collected during the treatment (1st session; pre and post 10th session) and plasma catecholamines and cortisol measured to determine basal levels and changes induced by the behavioral therapy. The clinical efficacy of BFB treatment for tension headache and common migraine was confirmed. The basal values of the plasma stress indices were significantly different between the two groups, but did not change during treatment. The lack of correlation between the clinical improvement and the biological indices monitored indicates the need for further studies with standardized protocols in order to probe the mechanism of action of these effective behavioral therapies.

Hypnosis and autogenic training in the treatment of tension headaches: A two-phase constructive design study with follow-up

Tension headaches can form a chronic (very long duration) condition. EMG biofeedback, relaxation training and analgesia by hypnotic suggestion can reduce the pain. So far, no differences have been demonstrated between the effects of various psychological treatments. In a constructively designed study, we firstly compared an abbreviated form of autogenic training to a form of hypnotherapy (future oriented hypnotic imagery) which was not presented as hypnosis and secondly we compared both treatments to the same future oriented hypnotic imagery, but this time explicitly presented as hypnosis. The three treatments were equally effective at post-treatment, but after a 6-month follow-up period, the future oriented hypnotic imagery which had been explicitly presented as hypnosis was superior to autogenic training. Contrary to common belief, it could be demonstrated that the therapists were as effective with the treatment modality they preferred as with the treatment modality they felt to be less remedial.

Electromyographic biofeedback training for tension headache in the elderly: A prospective study

This study evaluated the effects of a 12-session frontal electromyographic biofeedback training regimen on the headache activity of eight tension headache sufferers aged 62 and older. The biofeedback sessions were slightly modified for a geriatric population, essentially to increase comprehension and retention of rationale and instructions. Post-treatment assessment at three months revealed significant decreases in overall headache activity (50% or greater) in 50% of the subjects, and moderate improvement (35%-45%) in three of the remaining four subjects. Significant clinical and/or statistical pre-post differences were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of biofeedback training for tension headache in an elderly population and, unlike previous retrospective studies, suggests that such therapy may be an effective intervention in the treatment of tension headaches in the elderly.

Autogenic Training and Future Oriented Hypnotic Imagery in the Treatment of Tension Headache: Outcome and Process

The aim of the present study was (a) to investigate the relative efficacy of autogenic training and future oriented hypnotic imagery in the treatment of tension headache and (b) to explore the extent to which therapy factors such as relaxation, imagery skills, and hypnotizability mediate therapy outcome. Patients were randomly assigned to the 2 therapy conditions and therapists. 55 patients (28 in the autogenic therapy condition and 27 in the future oriented hypnotic imagery condition) completed the 4 therapy sessions and 2 assessment sessions. No significant main effect or interaction effects for treatment condition or therapist was revealed. A significant effect for time in analyzing scores for headache pain, pain medication usage, depression, and state anxiety was found. In the self-hypnosis condition, pain reduction proved to be associated with depth of relaxation during home practice (as assessed with diaries) and capacity to involve in imagery (as assessed with the Dutch version [van der Velden & Spinhoven, 1984] of the Creative Imagination Scale [Barber & Wilson, 1978/79; Wilson & Barber, 1978]). After statistically controlling for relaxation and imagery, hypnotizability scores (as assessed with the Dutch version [Oyen & Spinhoven, 1983] of the Stanford Hypnotic Clinical Scale [Morgan & J.R. Hilgard, 1975, 1978/79]) were significantly correlated with ratings of pain reduction. Results are discussed in the context of the neo-dissociation and social-cognitive model of hypnoanalgesia. The clinical relevance and the methodological shortcomings of the present study are also critically assessed.

The role of regular home practice in the relaxation treatment of tension headache.

This study evaluated the contribution of regular home practice in the treatment of tension headache (HA) with progressive muscle relaxation (PMR) by giving 14 tension HA sufferers 10 sessions (over 8 weeks) of standard PMR with home practice and application instructions while 13 additional patients received the same PMR training (except for the omission of cue-controlled relaxation) with no home practice or application instruction. A third group of 6 patients merely monitored HA activity. Both treated groups showed significant reduction in HA activity, whereas the symptom monitoring group did not change. The 2 treated groups did not differ. On a measure of clinically significant reduction in HA activity (at least 50% reduction in HA activity), however, the group receiving home practice instruction (50%) showed a trend (p = .056) to improve more than did those receiving PMR without home practice (15%).

The treatment of tension headache by acupuncture: A controlled single case design with time series analysis

A single case design, with time series analysis, was employed to evaluate the efficacy of acupuncture in the treatment of tension headache. Fourteen patients were given eight weekly treatments, four of true acupuncture and four of sham in random order. Mean pain in medication scores were reduced by 52% and 54% respectively at initial follow-up. Reductions in pain scores of over 50% were achieved by half the patients and the significance of these changes confirmed by time series analysis. The majority of patients maintained their gains at four month follow-up. True acupuncture was shown to be significantly superior to sham, demonstrating a specific therapeutic action, in four patients. In the remainder no difference was observed. Possible mechanisms for these effects are discussed. Acupuncture is a potentially valuable treatment for tension headache but further research is needed.

Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache.

Sixty-six tension headache patients were randomly assigned to one of four conditions for 8 weeks: (a) progressive muscle relaxation (PMR) alone; (b) PMR plus cognitive therapy (PMR + Cog); (c) pseudomeditation, a credible attention-placebo control; or (d) continued headache monitoring. A comparison of overall headache activity (headache index), derived from a daily headache diary, for 4 weeks before treatment to 4 weeks after treatment, revealed that active treatment (PMR and PMR + Cog) was superior to either control condition. Moreover, level of headache medication consumption decreased significantly for the active treatment groups. Although headache-index comparisons of the two active treatments showed no advantage for adding cognitive therapy to PMR, a measure of clinically significant change showed a trend for PMR + Cog to be superior to PMR alone.