Behavioral Treatments of Chronic Tension‐Type Headache in Adults: Are They Beneficial?

To assess the efficacy of behavioral treatments in patients with tension headache. Medline, Cinahl, EMBASE, and the Cochrane library were searched from inception to October 2007 and reference lists were checked. We selected randomized trials evaluating behavioral treatments (e.g., relaxation, electromyographic [EMG] biofeedback, and cognitive behavioral training) in patients with tension-type headache (TTH). We assessed the risk of bias using the Delphi list and extracted data from the original reports. A qualitative analysis was carried out. We found 44 trials (2618 patients), which were included in this review, of which only 5 studies (11.4%) were considered to have low risk of bias. Most trials lacked adequate power to show statistical significant differences, but frequently, recovery/improvement rates did not reach clinical relevance. In 8 studies, relaxation treatment was compared with waiting list conditions, and in 11 studies, biofeedback was compared with waiting list conditions, both showing inconsistent results. On the basis of the available literature, we found no indications that relaxation, EMG biofeedback, or cognitive behavioral treatment is better than no treatment, waiting list, or placebo controls.     

Towards a Functional Model of Chronic Headaches: Investigation of Antecedents and Consequences

SYNOPSIS
The traditional approach to classifying headache based on symptoms and assumed mechanisms is criticized as having limited utility when applied to tension-type headache and migraine. The study reported here was designed to explore an alternative method of conceptualizing chronic headaches based on functional characteristics or controlling variables. One hundred and ninety nine chronic headache sufferers completed questionnaires which enquired about the antecedents and consequences of their headaches. An attempt to build a categorical model driven by functional characteristics using cluster analysis was unsuccessful but a subsequent attempt to construct a dimensional model using factor analysis proved more successful. This approach led to the emergence of five antecedent dimensions and six consequences dimensions (three pertaining to the responses of sufferers and three to the reactions of significant others) which were readily identifiable. The functional dimensions were significantly related to traditional diagnostic categories but at a low level. Three functional dimensions predicted response to psychological treatment.     

帕罗西汀联合安定在预防紧张型头痛临床效果分析

目的探讨和分析神经内科门诊中帕罗西汀联合安定预防紧张型头痛的临床效果。方法随机性选取我院86例紧张型头痛患者分成联合组和对照组。联合组(46例)使用帕罗西汀(30 mg/d)联合安定进行抗焦虑治疗,对照组(40例)使用常规抗抑郁药联合安定治疗。分析对比两组对头痛的疗效和不良反应情况。结果联合组头痛疗效有效率为89.1%,头痛明显缓解,基本没有不良反应;与对照组治疗效果比较,差异均有统计学意义(P<0.05)。结论帕罗西汀联合安定预防和治疗紧张型头痛有显著的疗效,且不良反应少。     

Análisis de la efectividad de la técnica de punción seca en cefaleas: revisión sistemática

IntroductionNon-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache.MethodsWe performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers.ResultsOf a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes.ConclusionsDry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments.     

Headache

Headache, an almost universal human experience, is one of the most common complaints encountered in medicine and neurology. Described and categorized since antiquity, with the first classification by Aretaeus of Cappadocia, other classifications followed. The evaluation of this condition may be straightforward or challenging, and, though often benign, headache may prove to be an ominous symptom. This review discusses the current diagnosis and classification of headache disorders and principles of management, with a focus on migraine, tension-type headache, trigeminal autonomic cephalgias, and various types of daily headache.     

紧张型头痛患者咀嚼肌外感受抑制实验研究

目的:探讨三叉神经颞肌、咬肌外感受抑制(ES)检测紧张型头痛(TTH)的应用价值。方法:对30名紧张型头痛患者及30名正常志愿者利用肌电图(EMG)刺激眶下神经进行ES试验,检测颞肌、咬肌ES的潜伏期和时限。结果:与正常对照相比,紧张型头痛患者的第二抑制期(ES2)潜伏期延长,时限缩短,出现率降低(P<0.05)。结论:外感受抑制检查对紧张型头痛具有一定的诊断和研究价值。     

Needle acupuncture in tension-type headache: a randomized, placebo-controlled study

A study with needle acupuncture was performed in tension-type headache employing a new placebo acupuncture METHOD: Sixty-nine patients (mean age 48.1 years, SD = 14.1) fulfilling the International Headache Society criteria for tension-type headache were randomly assigned to verum or placebo condition. No significant differences between placebo and verum with respect to visual analogue scale and frequency of headache attacks could be observed immediately, 6 weeks and 5 months after the end of treatment. There was a significant but weak improvement in quality of life parameters (clinical global impressions, Nottingham Health Profile) after verum treatment. In decision tree analyses, the changes in clinical global impressions and headache frequency depended significantly on primary headache frequency with a limit value of 24.5 days headache per month. High values in the von Zerssen Depression Score resulted in high mean visual analogue scale values.     

盐酸乙哌立松治疗伴有颈椎异常的紧张型头痛的疗效及安全性

目的：观察盐酸乙哌立松治疗伴有颈椎异常的紧张型头痛的治疗效果及安全性。方法：采用开放性研究，患者226例，每日口服盐酸乙哌立松150mg，治疗时间为4周。在疗程开始前用药后第2周、4周分别记录头痛的强度、持续时间、频率、部位、性质和不良事件，并测定颈肌的痛阈。结果：治疗前与治疗第二周和第四周相比，盐酸乙哌立松明显减轻头痛程度和减少头痛频率，对于缓解颈肌张力和颈肌压痛明显有效。约有7％的病人在服药期间有轻度肢体无力、嗜睡、头晕及胃肠道反应等不适。结论：盐酸乙哌立松是治疗伴有颈椎异常的紧张型头痛安全有效的药物。     

The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency?

According to recent observations, there is worldwide vitamin D insufficiency (VDI) in various populations. A number of observations suggest a link between low serum levels of vitamin D and higher incidence of chronic pain. A few case reports have shown a beneficial effect of vitamin D therapy in patients with headache disorders. Serum vitamin D level shows a strong correlation with the latitude. Here, we review the literature to delineate a relation of prevalence rate of headaches with the latitude. We noted a significant relation between the prevalence of both tension-type headache and migraine with the latitude. There was a tendency for headache prevalence to increase with increasing latitude. The relation was more obvious for the lifetime prevalence for both migraine and tension-type headache. One year prevalence for migraine was also higher at higher latitude. There were limited studies on the seasonal variation of headache disorders. However, available data indicate increased frequency of headache attacks in autumn–winter and least attacks in summer. This profile of headache matches with the seasonal variations of serum vitamin D levels. The presence of vitamin D receptor, 1α-hydroxylase and vitamin D-binding protein in the hypothalamus further suggest a role of vitamin D deficiency in the generation of head pain.