Regional homogeneity alterations in multi-frequency bands in tension-type headache: a resting-state fMRI study

ObjectivesIn this study, we aimed to investigate the spontaneous neural activity in the conventional frequency band (0.01−0.08 Hz) and two sub-frequency bands (slow-4: 0.027–0.073 Hz, and slow-5: 0.01–0.027 Hz) in tension-type headache (TTH) patients with regional homogeneity (ReHo) analyses.MethodsThirty-eight TTH patients and thirty-eight healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (RS-fMRI) scanning to investigate abnormal spontaneous neural activity using ReHo analysis in conventional frequency band (0.01−0.08 Hz) and two sub-frequency bands (slow-4: 0.027–0.073 Hz and slow-5: 0.01–0.027 Hz).ResultsIn comparison with the HC group, patients with TTH exhibited ReHo increases in the right medial superior frontal gyrus in the conventional frequency band (0.01−0.08 Hz). The between group differences in the slow-5 band (0.01–0.027 Hz) highly resembled the differences in the conventional frequency band (0.01−0.08 Hz); even the voxels with increased ReHo were spatially more extensive, including the right medial superior frontal gyrus and the middle frontal gyrus. In contrast, no region showed significant between-group differences in the slow-4 band (0.027–0.073 Hz). The correlation analyses showed no correlation between the ReHo values in TTH patients and VAS scores, course of disease and number of seizures per month in conventional band (0.01−0.08 Hz), slow-4 band (0.027–0.073 Hz), as well as in slow-5 band (0.01–0.027 Hz).ConclusionsThe results showed that the superior frontal gyrus and middle frontal gyrus were involved in the integration and processing of pain signals. In addition, the abnormal spontaneous neural activity in TTH patients was frequency-specific. Namely, slow-5 band (0.01–0.027 Hz) might contain additional useful information in comparison to slow-4 band (0.027−0.073 Hz). This preliminary exploration might provide an objective imaging basis for the understanding of the pathophysiological mechanism of TTH.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-021-01341-4.     

中药治疗紧张性头痛的临床研究证据图

目的：系统收集中药治疗紧张性头痛(TTH)临床研究的现有证据,评价中药治疗紧张性头痛临床研究的现状。方法：计算机检索国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)、EMbase、PubMed、Cochrane Library、Web of science、ClinicalTrials.gov和中国临床试验注册中心共10个数据库,检索时限为建库至2020年10月,纳入有关中药治疗TTH的临床研究,采用证据图方法呈现临床研究的证据分布情况。结果：共纳入471项临床研究,其中随机对照试验378项,非随机对照试验41项,队列研究1项,病例系列研究51项,文献总发表数量在总体上随时间变化呈增长趋势,但呈“锯齿状”波动;方法学质量评价结果显示目前中药治疗紧张性头痛的临床研究质量较低;中药治疗紧张性头痛对总有效率、安全性事件、头痛持续时间、头痛强度、头痛发作频率、焦虑抑郁量表关注度较高,对经济学指标及远期预后指标关注较低。疗程集中在15～30 d。结论：目前中药治疗TTH的临床研究质量较低,未来需要开展更多高质量的临...     

Chronic Tension-Type Headache: An Investigation of the Appraisal Process

SYNOPSIS
The few existing studies that have explicitly examined appraisal of stress in tension-type headache sufferers have found that these individuals perceive events in a more negative manner than headache-free controls. However, can it necessarily be assumed that they perceive events in a less accurate manner than headache-free controls? To answer this question, sixty chronic tension-type headache sufferers and 60 controls engaged in a 40-trial contingency learning task in which they had to estimate the amount of control they could exert. Results provide little support for the notion that the cognitive appraisal of tension-type headache sufferers is more accurate than that of headache-free individuals. However, differences were found in perceived control when behavioral involvement was considered. This result is discussed in terms of learned helplessness theory.     

Terapia manual en adultos con cefalea tensional: revisión sistemática

IntroductionTension-type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely used in the clinical field to treat the symptoms associated with tension-type headache. This systematic review aims to determine the effectiveness of manual and non-invasive therapies in the treatment of patients with tension-type headache.DevelopmentWe conducted a systematic review of randomised controlled trials in the following databases: Brain, PubMed, Web of Science, PEDro, Scopus, CINAHL, and Science Direct. Ten randomised controlled trials were included for analysis. According to these studies, manual therapy improves symptoms, increasing patients’ well-being and improving the outcome measures analysed.ConclusionsManual therapy has positive effects on pain intensity, pain frequency, disability, overall impact, quality of life, and craniocervical range of motion in adults with tension-type headache. None of the techniques was found to be superior to the others; combining different techniques seems to be the most effective approach.     

Plasma nitrite levels,total antioxidant status,total oxidant status,and oxidative stress index in patients with tension-type headache and fibromyalgia

Objectives

Tension-type headache (TTH) and fibromyalgia syndrome (FM) are worldwide seen chronic pain syndromes of unknown etiology. Despite the growing body of data on pathophysiology and generation mechanisms of pain; our knowledge on pain mechanisms in both FM and TTH is yet to be limited.

Patients and methods

We investigated the plasma nitrite levels, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) in 35 TTH, 33 FM patients and 31 healthy controls.

Results

The mean plasma nitrite levels and TAS levels were significantly low and OSI was found to be significantly high in TTH and FM groups compared to the control group (p = 0.001, p = 0.001, p = 0.001 and p = 0.001, respectively). The mean serum TOS levels were also significantly higher in FM group according to the control group (p = 0.034), but there was not a significant difference between TTH and control groups (p = 0.066).

Conclusion

These results indicated that; FM and TTH patients revealed higher oxidative stress index and lower total nitrite levels than healthy controls. We conclude that oxidative stress may have a role in the pathophysiological mechanisms of TTH and FM, although, whether it is the cause or the consequence, is not clear.     

The features and burden of headaches within a chiropractic clinical population: A cross-sectional analysis

ObjectivesThe aim of this study is to a) investigate the headache features and level of headache severity, chronicity, and disability found within a chiropractic patient population and b) to ascertain if patient satisfaction with headache management by chiropractors is associated with headache group or reason for consulting a chiropractor.Design and settingConsecutive adult patients with a chief complaint of headache participated in an online cross-sectional survey (n = 224). Recruitment was via a randomly selected sample of Australian chiropractors (n = 70). Headache features were assessed using International Classification of Headache Disorders criteria and level of headache disability measured using the Headache Impact Test instrument.ResultsOne in four participants (n = 57; 25.4%) experienced chronic headaches and 42.0% (n = 88) experienced severe headache pain. In terms of headache features, 20.5% (n = 46) and 16.5% (n = 37) of participants had discrete features of migraine and tension-type headache, respectively, while 33.0% (n = 74) had features of more than one headache type. ‘Severe’ levels of headache impact were most often reported in those with features of mixed headache (n = 47; 65.3%) and migraine (n = 29; 61.7%). Patients who were satisfied or very satisfied with headache management by a chiropractor were those who were seeking help with headache-related stress or to be more in control of their headaches.ConclusionMany with headache who consult chiropractors have features of recurrent headaches and experience increased levels of headache disability. These findings may be important to other headache-related healthcare providers and policymakers in their endeavours to provide coordinated, safe and effective care for those with headaches.     

Mechanisms of tension-type headache

Despite tension-type headache represents one of the most frequent and costly diseases in modern society only very little research on this disease has actually been carried out. In contrast to former belief tension-type headache is a separate entity that can and should be separated from migraine. No specific biochemical abnormalities have yet been identified but a reliable human model of tension-type headache has been developed by means of infusion of a NO-donor, glyceryl trinitrate. Myofascial factors and peripheral sensitization of nociceptors play an important role in the episodic form, and central sensitization has been demonstrated in the chronic form. As chronic tension-type headache usually evolves from the episodic form, prevention and reversal of this central sensitization may be an important target for future pathophysiological studies and drug development.     

Tender points are not sites of ongoing inflammation -in vivo evidence in patients with chronic tension-type headache

Increased muscle tenderness is the most prominent finding in patients with tension-type headache, and it has recently been shown that muscle blood flow is diminished in response to static exercise in tender points in these patients. Although tenderness has been ascribed to local inflammation and release of inflammatory mediators, the interstitial concentration of inflammatory mediators has not previously been studied in tender muscles of patients with tension-type headache. The aim of the present study was to investigate in vivo concentrations of prostaglandin E2 (PGE2), adenosine 5'-triphosphate (ATP), glutamate, bradykinin and other metabolites in a tender point of patients with chronic tension-type headache, in the resting state as well as in response to static exercise, and to compare findings with measurements in a matched non-tender point of healthy controls. We recruited 16 patients with chronic tension-type headache and 17 healthy control subjects. Two microdialysis catheters were inserted into the trapezius muscle and dialysates were collected at rest, 15 and 30 min after start of static exercise (10% of maximal force) and 15 and 30 min after end of exercise. All samples were coded and analysed blindly. There was no difference in resting concentration of any inflammatory mediators or metabolites between tender patients and non-tender controls (P > 0.05). We also found no difference in change in interstitial concentration of ATP, PGE2, glutamate, glucose, pyruvate and urea from baseline to exercise and post-exercise periods between patients and controls (P > 0.05). The present study provides in vivo evidence of normal interstitial levels of inflammatory mediators and metabolites in tender trapezius muscle in patients with chronic tension-type headache during both rest and static exercise. Thus, our data suggest that tender points in these patients are not sites of ongoing inflammation.     

Genetics of tension-type headache

Abstract The objective of this study was to investigate the importance of genetics in tension-type headache. A MEDLINE search from 1966 to December 2006 was performed for “tension-type headache and prevalence” and “tension-type headache and genetics”. The prevalence of tensiontype headache varies from 11 to 93%, with a slight female preponderance. Co-occurrence of migraine increases the frequency of tension-type headache. A family study of chronic tension-type headache suggests that genetic factors are important. A twin study analysing tension-type headache in migraineurs found that genetic factors play a minor role in episodic tension-type headache. Another twin study analysing twin pairs without co-occurrence of migraine showed a significantly higher concordance rate among monozygotic than same-gender dizygotic twin pairs with no or frequent episodic tension-type headache, while the difference was minor in twin pairs with infrequent episodic tensiontype headache. Frequent episodic and chronic tension-type headache is caused by a combination of genetic and environmental factors, while infrequent episodic tensiontype headache is caused primarily by environmental factors. 1 This is a “Springer Open Choice” article. Unrestricted non-commercial use, distribution, and reproduction in any medium is permitted, provided the original author and source are credited.     

Acute pharmacotherapy of migraine,tension-type headache,and cluster headache

Abstract In most migraine patients acute therapy is needed. Migraine can be treated either with specific drugs, the triptans and ergot alkaloids, or with NSAIDs. Triptans are a major step foreward in migraine therapy. The therapeutic gain for headache relief is 50% for subcutaneous sumatriptan whereas it is 30-40% for most oral triptans. After oral triptans sustained pain free is only 30%. There is thus still ample room for improvement of acute therapy in migraine. For tension-type headache there is no specific therapy and it is treated with NSAIDs. Only 17-32% become pain free after these drugs. For attacks of cluster headache oxygen and subcutaneous sumatriptan can be used. Intranasal triptans can be an alternative.