scholarly journals Evidence Based Migraine Prophylactic Drug Therapy

1999 ◽  
Vol 26 (3) ◽  
pp. 27-32 ◽  
Author(s):  
W.J. Becker
Keyword(s):  
Clinical Trials ◽  
Drug Therapy ◽  
Scientific Evidence ◽  
Tension Type Headache ◽  
Beneficial Effects ◽  
Symptomatic Medication ◽  
Prophylactic Drugs ◽  
Prophylactic Drug ◽  
Patient Will ◽  
Type Headache

Prophylactic drug therapy is a major component of overall migraine management. However, because we do not know how currently used prophylactic drugs exert their beneficial effects in migraine, their use is based primarily on clinical trials. In general, prophylactic drugs are indicated when patients have three or more attacks a month and symptomatic medication use alone is not satisfactory. The choice of drug must be individualized, and is influenced by contraindications, potential side effects, the need to treat associated symptoms like tension-type headache and insomnia, and drug cost. Whether an individual patient will respond to a given drug cannot be predicted, but there are varying degrees of scientific evidence supporting the use of each prophylactic drug in migraine. This evidence is best for metoprolol, divalproex, amitriptyline, atenolol, flunarizine and naproxen. Based on placebo-controlled crossover studies, it would appear that at least some prophylactic drugs exert the greater part of their prophylactic effects very quickly, and that these also disappear very quickly once the drug is stopped. This may not apply to all prophylactic drugs and more research is needed. More well designed clinical trials are needed to guide our use of migraine prophylactic drugs. Although clinical experience is useful, placebo responses and variations in the migraine tendency over time can make interpretation of this experience difficult. Major advances will likely only occur once the pathogenesis of migraine and the mode of action of the prophylactic drugs is better understood.

Tension-type headache in patients with concomitant musculoskeletal disorders

2020 ◽  
pp. 72-79
Author(s):  
Yu. O. Novikov ◽  
I. E. Salakhov
Keyword(s):  
Cervical Spine ◽  
Drug Therapy ◽  
Drug Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Tension Type Headache ◽  
World Health ◽  
Standard Drug ◽  
Rehabilitation Treatment ◽  
Type Headache

Introduction. According to the defi nition of the World Health Organization (WHO), tension-type headache (TTH) is the most common type of primary headache. Rehabilitation of patients with chronic tension-type headache continues to be an important socio-medical problem. Its main goal is the most complete restoration of the functions of the musculoskeletal system of the neck, the correction of vascular and psychoemotional problems, and the patient′s return to his everyday life and work. As a rule, the main emphasis in the treatment of such patients is placed primarily on drug therapy. At the same time, practitioners are faced with a number of problems — the low effectiveness of the treatment, the nonpersistency of the results, allergic reactions, polypharmacy and others. All this suggests that there is a need for differentiated rehabilitation treatment of patients with tension-type headache with the use of various non-pharaceutical methods. The goal of research — to evaluate the clinical effi cacy of complex non-drug therapy in patients with tension-type headache.Materials and methods. The prospective controlled randomized study, which was conducted from October 2017 to March 2019 at the Department of Medical Rehabilitation of the Bashkir State Medical University, included 110 patients with TTH from the age of 20 to 45 years. All patients, depending on the treatment methodology used, were randomly divided into two groups of 55 people. Patients of the main group received complex rehabilitation treatment with the use of non-drug methods: osteopathic correction, acupuncture and exercise therapy. Patients in the control group received treatment in accordance with the standard of medical care for TTH (analgesics, non-steroidal antiinfl ammatory drugs, antidepressants, vasoactive and nootropic drugs). The study of the clinical effectiveness of the therapy included: an assessment of the severity of pain with the use of a visual analogue scale and a tensoalgimeter, a goniometric study with an assessment of the volume of active movements in the cervical spine, transcranial ultrasound dopplerography with an assessment of quantitative indicators in the system of the middle cerebral artery.Results. The use of complex non-drug therapy in patients with TTH compared with standard drug therapy leads to a signifi cantly more important decrease in the severity of pain, an increase in pain threshold, an increase in the volume of active movements in the cervical spine. The effect of non-drug treatment methods on blood fl ow in the system of the middle cerebral artery is comparable in its effectiveness with the use of pharmaceutical drugs.Conclusion. The proposed complex rehabilitation treatment of patients with TTH with the use of non-drug methods has shown clinical effi cacy which is comparable, and in a number of indicators, superior to the effectiveness of conventional medical treatment. All this determines the necessity of wider implementation of multidisciplinary non-drug treatment of patients with this pathology.

scholarly journals Effects of Neural Mobilization Techniques on Painand Disabilityin PatientsWith Neurodynamic Dysfunction: A Systematic Review of Randomized Controlled Trials

2021 ◽  
Author(s):  
Hasan Shamsi ◽  
Khosro Khademi-Kalantari ◽  
Farshad Okhovatian
Keyword(s):  
Clinical Trials ◽  
Nervous System ◽  
Randomized Clinical Trials ◽  
Tension Type Headache ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Level 3 ◽  
Tunnel Syndrome ◽  
Type Headache

Introduction: Neural mobilization is the most important  technique  used for the treatment  of nervous system dysfunction. This study aimed to systematically review and evaluate the therapeutic efficacy of neural mobilization techniques in nervous system dysfunctions by assessing Randomized Controlled Clinical Trials (RCTs). Materials and Methods: We used all English papers published in five electronic databases from 2000 to 2020 using the following keywords: “neural mobilization”, “nerve mobilization”, “physical therapy”, “nerve glide exercises”, “neural stretching”, “neurodynamics”, and “neural physiotherapy”. The full text of the articles identified was reviewed to select papers specifically discussing neural mobilization as a treatment modality. The PEDro scale was used to assess the quality of these trials. The randomized clinical trials were selected that examined the therapeutic effect of neural mobilization. Results: Twelve RCTs were identified. Five RCTs used the same median nerve tensioning technique in patients  with Carpal Tunnel  Syndrome  (CTS).  In some studies, the methods  of neural mobilization were different. Fourteen papers examined different neurodynamic dysfunctions such as lateral epicondylalgia, radicular neck pain, postoperative spinal surgery, radicular low back pain, and chronic tension-type headache. There is moderate evidence (Level 2) to support distal nerve tensioning and tendon gliding techniques in CTS Also, there was limited (Level 3) and insufficient (Level 4) evidence about using cervical lateral gliding away from their involved side and upper limb tension test mobilization and the use of slump stretches and combinations techniques in the treatment of neurodynamic dysfunction, respectively. Besides, all studies reported a positive effect compared to neutral effects. Conclusion: Although clinicians frequently use neuromobilization techniques for both diagnosis and treatment of nervous system dysfunctions, the quality assessment of 20 RCTs has shown insufficient evidence to support the efficacy of these techniques in the treatment of nervous system dysfunctions.

Definitions and participant characteristics of frequent recurrent headache types in clinical trials: A systematic review

Cephalalgia ◽  
2017 ◽  
Vol 38 (4) ◽  
pp. 786-793 ◽  
Author(s):  
Maria-Eliza R Aguila ◽  
Trudy Rebbeck ◽  
Kristofferson G Mendoza ◽  
Mary-Grace L De La Peña ◽  
Andrew M Leaver
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Cluster Headache ◽  
Cervicogenic Headache ◽  
Tension Type Headache ◽  
Inclusion Criteria ◽  
Recurrent Headache ◽  
Episode Frequency ◽  
Type Headache

Background Clear definitions of study populations in clinical trials may facilitate application of evidence to clinical populations. This review aimed to explore definitions of study populations in clinical trials on migraine, tension-type headache, cluster headache, and cervicogenic headache. Methods We performed a systematic review of clinical trials investigating treatment efficacy for migraine, tension-type headache, cluster headache, and cervicogenic headache. We extracted data on diagnosis, inclusion criteria and baseline headache characteristics. Results Of the 229 studies reviewed, 205 studies (89.5%) defined their populations in adherence to the International Classification of Headache Disorders (ICHD) criteria. Some studies ( n = 127, 55.5%) specified diagnosing through interview, clinical examination and diary entry. The most commonly reported inclusion criteria were pain intensity for migraine and tension-type headache studies ( n = 123, 66.1% and n = 21, 67.7%, respectively), episode frequency ( n = 5, 71.4%) for cluster headache studies, and neck-related pain for cervicogenic headache studies ( n = 3, 60%). Few studies reported details on the extent to which diagnostic criteria were present at baseline. Conclusions ICHD is routinely used in defining populations in headache studies. Details of baseline headache characteristics were not as consistently reported.

scholarly journals Incidental Treatment of a Subclinical Chronic Tension-Type Headache by Cosmetic Use of Botulinum Toxin A: A Case Report

2017 ◽  
Vol 9 (3) ◽  
pp. 249-253
Author(s):  
Iselin Saltvig ◽  
Steen Henrik Matzen
Keyword(s):  
Botulinum Toxin ◽  
Chronic Headache ◽  
Botulinum Toxin A ◽  
Tension Type Headache ◽  
Toxin A ◽  
Beneficial Effects ◽  
Migraine Headaches ◽  
Type Headache ◽  
Tension Type Headaches

Background: Headache is a common disorder of the nervous system; chronic headache in particular may affect quality of life negatively. The pathophysiology is multifactorial and not completely elucidated. Studies have demonstrated the beneficial effects of botulinum toxin A on chronic migraine headaches, but failed to show the same effect on chronic tension-type headaches. Methods: We present the case of a 32-year-old woman who after receiving cosmetic injections with botulinum toxin A for fine lines of the forehead experienced relief of subclinical tension-type headaches. Conclusions: Although the effect of botulinum toxin A on chronic tension-type headaches is limited, several studies demonstrate its pain-modulating effects, and as such it is worth paying attention to this potential beneficial effect when performing cosmetic injections with botulinum toxin A.

scholarly journals Acupuncture as a therapeutic option for tension-type headache: A Systematic Review

2021 ◽  
Author(s):  
Camila Puton, Caio de Almeida Lellis ◽  
Caio Reis Borges ◽  
Giovanna Garcia de Oliveira
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Relaxation Training ◽  
Randomized Clinical Trials ◽  
Therapeutic Option ◽  
Control Process ◽  
Tension Headache ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Type Headache

Introduction: Tension headache (TTS), the most common type of primary headache, is characterized by tightness pain, typically bilateral, lasting hours or days, significantly impairing daily activities. Objectives: To review the literature on the use of acupuncture in the management of TTS, evaluating its safety and efficacy. Design and setting: A systematic review conducted at the Pontifical Catholic University of Goiás. Methods: A systematic literature review was performed in the PubMed, EMBASE and Virtual Health Library databases, with the terms: “Tension-Type Headache AND Acupuncture”. Randomized studies and clinical trials published in the last 10 years were selected. Results: Two studies, one clinical trial and one randomized trial, concluded that combining acupuncture with another therapy involving movement, such as stretching, physical therapy techniques, or relaxation training, led to reduced pain intensity and improved quality of life in patients with TTS. In contrast, other randomized clinical trials concluded that relaxation training decreased the intensity, frequency of attacks, and adjunctive symptoms of headache (sleep and vitality) more than acupuncture. Finally, acupuncture was compared with the simulated control process in the prevention of TTS, but there were no statistically significant differences between the two groups evaluated. Conclusion: The literature indicated that the combination of acupuncture with other therapeutic options was safe and effective in the management and prevention of TTS. Studies with greater scientific rigor should be conducted for a better understanding of this therapeutic option.

scholarly journals Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review

2009 ◽  
Vol 27 (2) ◽  
pp. 151-165 ◽  
Author(s):  
A. P Verhagen ◽  
L. Damen ◽  
M. Y Berger ◽  
J. Passchier ◽  
B. W Koes
Keyword(s):  
Systematic Review ◽  
Tension Type Headache ◽  
Prophylactic Drugs ◽  
Type Headache

scholarly journals The burden attributable to headache disorders in children and adolescents in Lithuania: estimates from a national schools-based study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Diana Genc ◽  
Nerija Vaičienė-Magistris ◽  
Apolinaras Zaborskis ◽  
Tayyar Şaşmaz ◽  
Aylin Yeniocak Tunç ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Medication Overuse Headache ◽  
Symptom Burden ◽  
Tension Type Headache ◽  
Emotional Impact ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Symptomatic Medication ◽  
Nationally Representative ◽  
Type Headache

Abstract Background We recently showed headache to be common in children (aged 7–11 years) and adolescents (aged 12–17) in Lithuania. Here we provide evidence from the same study of the headache-attributable burden. Methods Following the generic protocol for Lifting The Burden’s global schools-based study, this cross-sectional survey administered self-completed structured questionnaires to pupils within classes in 24 nationally representative schools selected from seven regions of the country. Headache diagnostic questions were based on ICHD-3 beta criteria but for the inclusion of undifferentiated headache (UdH; defined as mild headache with usual duration < 1 h). Burden enquiry was conducted in multiple domains. Results Questionnaires were completed by 2505 pupils (1382 children, 1123 adolescents; participating proportion 67.4%), of whom 1858 reported headache in the preceding year, with mean frequency (±SD) of 3.7 ± 4.5 days/4 weeks and mean duration of 1.6 ± 1.9 h. Mean proportion of time in ictal state, estimated from these, was 0.9% (migraine 1.5%, probable medication-overuse headache [pMOH] 10.9%). Mean intensity on a scale of 1–3 was 1.6 ± 0.6 (mild-to-moderate). Symptomatic medication was consumed on 1.5 ± 2.8 days/4 weeks. Lost school time was 0.5 ± 1.5 days/4 weeks (migraine 0.7 ± 1.5, pMOH 5.0 ± 7.8) based on recall, but about 50% higher for migraine according to actual absences recorded in association with reported headache on the preceding day. More days were reported with limited activity (overall 1.2 ± 2.4, migraine 1.5 ± 2.2, pMOH 8.4 ± 8.5) than lost from school. One in 30 parents (3.3%) missed work at least once in 4 weeks because of their son’s or daughter’s headache. Emotional impact and quality-of-life scores generally reflected other measures of burden, with pMOH causing greatest detriments, followed by migraine and tension-type headache, and UdH least. Burdens were greater in adolescents than children as UdH differentiated into adult headache types. Conclusions Headache in children and adolescents in Lithuania is mostly associated with modest symptom burden. However, the consequential burdens, in particular lost school days, are far from negligible for migraine (which is prevalent) and very heavy for pMOH (which, while uncommon in children, becomes four-fold more prevalent in adolescents). These findings are of importance to both health and educational policies in Lithuania.

Tension-type headache

2020 ◽  
pp. 259-266
Author(s):  
Stefan Evers
Keyword(s):  
Muscle Tension ◽  
Tension Type Headache ◽  
Central Pain ◽  
Pharmacological Management ◽  
Prophylactic Drugs ◽  
Pain Sensitization ◽  
Accompanying Symptoms ◽  
Type Headache ◽  
Antinociceptive Mechanisms

Tension-type headache (TTH) is usually a dull, bilateral headache without accompanying symptoms. It is divided into three subtypes: infrequent episodic TTH (< 1 headache day per month), frequent episodic TTH (1–14 headache days per month), and chronic TTH (≥ 15 headache days per month). This division is highly relevant for three reasons. Firstly, impact on quality of life differs considerably between the three subtypes. Secondly, the pathophysiological mechanisms also differ. Peripheral mechanisms such as muscle tension are more important in episodic TTH, whereas central pain sensitization with reduced antinociceptive mechanisms are pivotal in chronic TTH. Thirdly, treatment differs between the subtypes, with symptomatic and prophylactic treatment being more appropriate for episodic and chronic TTH, respectively. Non-pharmacological management should always be part of the treatment. Patients with episodic TTH are treated with analgesics, while prophylactic drugs (in particular antidepressants) should be considered in patients with very frequent episodic or chronic TTH.

Guidelines for Controlled Trials of Drugs in Tension-Type Headache: Second Edition

Cephalalgia ◽  
2009 ◽  
Vol 30 (1) ◽  
pp. 1-16 ◽  
Author(s):  
L Bendtsen ◽  
ME Bigal ◽  
R Cerbo ◽  
HC Diener ◽  
K Holroyd ◽  
...  
Keyword(s):  
Clinical Trials ◽  
International Headache Society ◽  
Tension Type Headache ◽  
Controlled Trials ◽  
Controlled Clinical Trials ◽  
Trial Methodology ◽  
New Information ◽  
Drug Treatments ◽  
Type Headache

The Clinical Trials Subcommittee of the International Headache Society published its first edition of the guidelines on controlled trials of drugs in tension-type headache in 1995. These aimed ‘to improve the quality of controlled clinical trials in tension-type headache’, because ‘good quality controlled trials are the only way to convincingly demonstrate the efficacy of a drug, and form the basis for international agreement on drug therapy’. The Committee published similar guidelines for clinical trials in migraine and cluster headache. Since 1995 several studies on the treatment of episodic and chronic tension-type headache have been published, providing new information on trial methodology for this disorder. Furthermore, the classification of the headaches, including tension-type headache, has been revised. These developments support the need for also revising the guidelines for drug treatments in tension-type headache. These Guidelines are intended to assist in the design of well-controlled clinical trials in tension-type headache.

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