Pharmacoprophylaxis of tension-type headache

Durable effects of acupuncture for tension-type headache: A systematic review and meta-analysis

Background

Acupuncture may be effective in treating tension-type headache (TTH). The durability of its effects after treatment completion remains inconclusive.

Methods

We searched multiple databases and references from previous reviews for randomized controlled trials (RCTs) which investigated the effectiveness of acupuncture for TTH. We assessed the methodological quality of RCTs using the Cochrane Risk of Bias 2.0 (RoB 2) tool. Primary outcome was response rate, defined as the proportion of participants who reported at least a 50% reduction in monthly headache days from baseline after completion of treatment. Secondary outcomes included headache days, headache intensity, and analgesic use. Safety outcomes were also evaluated.

Results

A total of seven RCTs involving 3,221 participants with frequent episodic and chronic TTH were included. Individuals receiving acupuncture reported a significantly higher response rate versus sham acupuncture (SA) immediately and at 1-6 months after completion of treatment (P<0.05). Compared with SA, post-treatment results of headache days and headache intensity appeared consistent on the whole, showing associations favoring acupuncture. However, no significant reduction in analgesic use was found post-treatment. Acupuncture showed no superiority over physical training or relaxation training in headache days and headache intensity. Moreover, no serious adverse events associated with acupuncture were reported.

Conclusion

Limited evidence suggested that acupuncture might provide durable post-treatment effects in the management of frequent episodic and chronic TTH for up to 6 months compared with SA,with no severe treatment-related adverse events reported.

Headaches in Adults in Primary Care: Evaluation, Diagnosis, and Treatment

Headaches are common in primary care. The diagnosis is made by a careful history and physical examination. Imaging is generally not warranted. Several general principles underlie the acute treatment of headache: early initiation of therapy and adequate dosing at first dose. Careful attention to avoiding too frequent administration of acute therapy is important to avoid medication overuse headaches. Opioids should always be avoided. Preventive treatment is indicated for frequent headaches. Successful treatment entails low-dose medication with careful titration and monitoring of headache frequency. Behavioral strategies are important and should be part of any comprehensive headache management plan.

Primary Headache Disorders- Part 2: Tension-type headache and medication overuse headache

In Part 2 of Primary Headache disorders, we discuss the fourth Primary Headache Disorder, Tension-Type Headache (TTHA). We are again using the ICHD-III (Beta) definitions of such headaches, taking into consideration episodic and chronic TTHA, as well as the presence or absence of pericranial muscle tenderness. We discuss the pathophysiology and pharmacotherapeutic treatment of TTHA, and the aspects of the Myofascial Pain Syndrome that enhance and help the development of TTHA. We then discuss Medication Overuse Headache (MOH), itself a Secondary headache disorder, but one that is extremely important as it assists with the chronification of both migraine and TTHA. Finally we discuss how to manage and treat those patients with MOH. Chronic migraine, which is TTHA, Migraine as well as, in many patients, MOH, is discussed along with the treatment of this multifaceted disorder.

Tension-type headache in the elderly

Tension-type headache is the most common primary headache disorder seen in adults. Although the prevalence peaks in the fourth and fifth decades of life, significant fractions of the elderly continue to experience either episodic or chronic tension-type headaches. Many secondary headache disorders may present with headaches symptomatically compatible with the diagnosis of tension-type headache. Because numerous secondary headache disorders are more likely to be seen in older adults, the diagnosis of tension-type headache requires vigilance for and exclusion of organic disease. Once the diagnosis of tension-type headache is made, numerous nonpharmacologic and pharmacologic management options are available to reduce the frequency and severity of episodes. Special dosing considerations must be considered in the elderly. Advancing age is a positive prognostic factor in the remission of episodic and chronic tension-type headaches.

Iatrogenic botulism in a child with spastic quadriparesis

Botulinum toxins are potent neurotoxins used in a variety of neurological disorders. Few pediatric reports have been published to date regarding the potential hazards of therapeutic use of botulinum toxins. We describe the case of a 10-year-old boy who developed systemic weakness following treatment of spasticity with botulinum toxin type B. The patient developed iatrogenic botulism with ptosis, facial diplegia, neck flexor and extensor weakness, and profound hypopharyngeal laxity with respiratory compromise from which he eventually recovered. Clinicians should be mindful of the risk for systemic botulism when using local injections of the neurotoxin.

Tension-type headache: the most common, but also the most neglected, headache disorder

PURPOSE OF REVIEW

Tension-type headache is the most common type of headache and, in its chronic form, one of the most neglected and difficult types of headache to treat. Recently published data will be reviewed.

RECENT FINDINGS

The prevalence of frequent tension-type headache increased significantly from 1989 to 2001, and several risk factors have been identified. The incidence decreases markedly with age. The prognosis is fairly favorable for the episodic forms. Chronic tension-type headache, coexisting migraine, sleep problems and not being married were identified as risk factors for a poor outcome. Previous reports of sensitization of the central nervous system in patients with chronic tension-type headache were confirmed by the findings of generalized pain hypersensitivity both in skin and in muscles, and of a decrease in the volume of gray matter in brain structures. A promising new animal model of tension-type headache has been developed. In addition, the efficacy of a prophylactic drug, mirtazapine, with fewer side-effects than the tricyclic antidepressants has been demonstrated.

SUMMARY

The new data on the prevalence, incidence and prognosis of tension-type headache are valuable for health care planning and in daily clinical practice. The increased knowledge with regard to abnormal central pain modulation, together with the development of an animal model, hold promise for much-needed improvements in the understanding of pathophysiological mechanisms and treatment.

At the crossroads between tension-type headache and fibromyalgia

Fibromyalgia syndrome and tension-type headache have multiple clinical features in common, and pathogenic mechanisms partly overlap. Significant differences need to be recognized as well. Studying the correlations of these often comorbid conditions represents a unique opportunity to gain insight into their pathophysiology and that of other chronic pain syndromes, to increase the accuracy of their diagnosis, and to improve the therapeutic armamentarium.

Tension-type headache in the elderly

Tension-type headache is the most common primary headache disorder seen in adults. Although the prevalence peaks in the fourth and fifth decades of life, significant fractions of the elderly continue to experience either episodic or chronic tension-type headaches. Many secondary headache disorders may present with headaches symptomatically compatible with the diagnosis of tension-type headache. Because numerous secondary headache disorders are more likely to be seen in older adults, the diagnosis of tension-type headache requires vigilance for and exclusion of organic disease. Once the diagnosis of tension-type headache is made, numerous nonpharmacologic and pharmacologic management options are available to reduce the frequency and severity of episodes. Special dosing considerations must be considered in the elderly. Advancing age is a positive prognostic factor in the remission of episodic and chronic tension-type headaches.