New developments in the pharmacotherapy of tension-type headaches

Pharmacotherapy and Lifestyle Interventions for Tension-Type Headaches

The objective of this review was to evaluate the efficacy of pharmacotherapy and lifestyle interventions for tension-type headaches. Literature was obtained through a MEDLINE (1966 to April 2008) search and a bibliographic review of published articles. Key terms searched included tension-type headaches, chronic tension-type headaches, pharmacotherapy, and lifestyle therapy. The search was further limited to the English language. Tension-type headaches are the most common and least studied primary headache disorder. These headaches are characterized by mild to moderate bilateral pain that is described as dull, aching, and bandlike. Episodic tension-type headaches may be treated with mild analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; although treatment should be individualized, data suggest that NSAIDs may be considered first line. Chronic and frequent episodic tension-type headaches often require prophylactic therapy. Although tricyclic antidepressants are considered the drugs of choice for chronic tension-type headaches, preliminary trials with venlafaxine, mirtazapine, tizanidine, and topiramate have shown promise. Lifestyle interventions such as physical therapy, behavioral therapy, and acupuncture are often employed, despite the lack of sound clinical evidence to support their use. Preliminary data support the combination of a tricyclic antidepressant and behavioral therapy for chronic tension-type headache.

Traditional and Evidence‐Based Acupuncture in Headache Management: Theory, Mechanism, and Practice

Acupuncture, traditional Chinese needle therapy, has become widely used for the relief of headache. The history of the practice of acupuncture in the United States and the theoretical framework for acupuncture in Chinese medicine are reviewed. The basic scientific background and clinical application of acupuncture in the headache management are discussed.

Future therapeutic perspectives for tension-type headache

The therapy for tension-type headache remains insufficient, and recent advances have been scarce. Although tricyclic antidepressants are at the forefront of treatment advances, upcoming agents tentatively modifying central sensitization are promising. Botulinum toxin failed to meet expectations. This article reviews current treatments, emphasizing newer approaches. Much remains to be achieved.

Use of Complementary and Alternative Medicine by Patients With Chronic Tension-Type Headache: Results of a Headache Clinic Survey

OBJECTIVES

This study was undertaken to evaluate the rates, pattern, and presence of predictors of complementary and alternative medicine use in a clinical population of patients with chronic tension-type headache.

BACKGROUND

The use of complementary and alternative medicine in the treatment of headaches is a growing phenomenon about which little is known.

METHODS

A total of 110 chronic tension-type headache patients attending a headache clinic participated in a physician-administered structured interview designed to gather information on complementary and alternative medicine use.

RESULTS

Past use of complementary and alternative therapies was reported by 40% of the patients surveyed (22.7% in the previous year). Chronic tension-type headache patients prefer complementary and alternative practitioner-administered physical treatments to self-treatments, the most frequently used being chiropractic (21.9%), acupuncture (17.8%), and massage (17.8%). Only 41.1% of the patients perceived complementary and alternative therapies to be beneficial. The most common source of recommendation of complementary and alternative medicine was a friend or relative (41.1%). Most of the chronic tension-type headache patients used complementary and alternative treatment as a specific intervention for their headache (77.3%). Almost 60% of complementary and alternative medicine users had not informed their medical doctors of their use of complementary and alternative medicine. The most common reasons given for choosing to use a complementary or alternative therapy was the "potential improvement of headache" it offered (45.4%). The patients who had used more complementary and alternative treatments were found to be those recording a higher lifetime number of visits to conventional medical doctors, those with a comorbid psychiatric disorder, those enjoying a higher (household) income, and those who had never tried a preventive pharmacological treatment.

CONCLUSIONS

Our findings suggest that headache-clinic chronic tension-type headache patients, in their need of and quest for care, seek and explore both conventional and complementary and alternative therapies, even if only 41.1% of them perceived complementary treatments as effective. Physicians should be made aware of this patient-driven change in the medical climate in order to prevent misuse of health care resources and to be better equipped to meet patients' care requirements.