Identifying Chinese Medicine Patterns of Tension-Type Headache and Understanding Its Subgroups

Tension-type headache (TTH) is common among adults. Individualized management strategies are limited due to lack of understanding of subtypes of TTH. Chinese medicine (CM) uses the pattern differentiation approach to subtype all health conditions. There is, however, a lack of evidence-based information on CM patterns of TTH. This study aimed to identity common CM patterns of TTH. TTH sufferers were invited for a survey, consisting of a validated Chinese Medicine Headache Questionnaire (CMHQ), Migraine Disability Assessment Test, and Perceived Stress Scale. The CMHQ consisted of information about headache, aggravating and relieving factors, and accompanying symptoms. Principal component analysis was used for factor extraction and TwoStep cluster analyses for identifying clusters. ANOVA was used to compare cluster groups with disability and stress. In total, 170 eligible participants took part in the survey. The commonest headache features were continuous pain (64%); fixed location (74%); aggravated by overwork (74%), stress (74%), or mental strain (70%); and relieved by sleeping (78%). The commonest nonpain symptoms were fatigue (71%) and neck stiffness (70%). Four clusters, differing in their key signs and symptoms, could be assigned to three different CM patterns including ascendant hyperactivity of liver yang (cluster 1), dual qi and blood deficiency (cluster 2), liver depression forming fire (cluster 3), and an unlabelled group (cluster 4). Additionally, over 75% participants in clusters 1 and 2 have episodic TTH, over one-third participants in cluster 3 have chronic TTH, and a majority of participants in cluster 4 have infrequent TTH. The three patterns identified also differed in levels of disability and some elements of coping as measured with PSS. The three CM patterns identified are common clinical presentations of TTH. The new information will contribute to further understanding of the subtypes of TTH and guide the development of targeted intervention combinations for clinical practice and research.

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Identifying Chinese Medicine patterns of Tension-type Headache (TTH) and its implication on understanding TTH subgroups

10.21203/rs.2.19621/v1 ◽

2019 ◽

Author(s):

Xinyu Hao ◽

Fanrong Liang ◽

Linpeng Wang ◽

Kenneth Mark Greenwood ◽

Charlie Changli Xue ◽

...

Keyword(s):

Chinese Medicine ◽

International Headache Society ◽

Principal Component ◽

Signs And Symptoms ◽

Tension Type Headache ◽

Mental Strain ◽

Neck Stiffness ◽

Targeted Interventions ◽

Symptom Patterns ◽

Type Headache

Abstract Background Acupuncture is commonly used to relieve tension-type of headache (TTH), however, there is a lack of consistent approach of devising acupuncture interventions for TTH due to limited evidence for symptom patterns according to Chinese medicine. This study aimed to identity common Chinese medicine symptom patterns of TTH.Methods We applied a validated Chinese Medicine Headache Questionnaire to a group of headache sufferers. The questionnaire consisted of information about headache, aggravating and relieving factors and accompanying symptoms. The Migraine Disability Assessment Test (MIDAS) was used to assess disability and the Perceived Stress Scale (PSS) for the level of stress. Information about comorbidities was collected. The modified International Headache Society TTH diagnostic criteria (ICHD-II) were used to screen the participants. Principal component analysis was used for factor extraction and Two-Step cluster analyses for clustering. One-way analysis of variance (ANOVA) was used to compare cluster groups in disability and stress.Results In total 170 participants, including 114 females and 56 males, met the selection criteria. The commonest headache features were continuous pain (64%) and fixed location (74%). Headache was aggravated by overwork (74%), stress (74%), and mental strain (70%) and relieved by sleeping (78%). The commonest accompanied symptoms were fatigue (71%) and neck stiffness (70%). Four clusters were identified with 46, 34, 46 and 44 participants in Clusters 1-4, respectively. Assessed by experts, the four clusters could be assigned to three different patterns, including Ascendant hyperactivity of Liver-Yang (Cluster 1), Dual Qi and Blood deficiency (Cluster 2), Liver depression forming Fire (Cluster 3), and an Un-labelled group (Cluster 4). The four clusters differed in their key signs and symptoms. Additionally, over 75% participants in clusters 1 and 2 were episodic TTH, over one third in Cluster 3 having chronic TTH, and the majority in Cluster 4 were in-frequent TTH. The three patterns identified also differed in levels of disability and some elements of coping as measured with PSS.Conclusion The three symptom patterns identified are common clinical presentations of TTH. The new information will contribute to further understanding of the subtypes of TTH and guide the development of targeted interventions, including acupuncture, for clinical practice and research.

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A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks

Cephalalgia ◽

10.1177/0333102419877661 ◽

2019 ◽

Vol 40 (4) ◽

pp. 337-346 ◽

Cited By ~ 3

Author(s):

Alberto Terrin ◽

Federico Mainardi ◽

Carlo Lisotto ◽

Edoardo Mampreso ◽

Matteo Fuccaro ◽

...

Keyword(s):

Prospective Study ◽

Diagnostic Criteria ◽

Migraine Without Aura ◽

Tension Type Headache ◽

Headache Disorders ◽

Headache Attack ◽

Accompanying Symptoms ◽

Type Headache ◽

A Prospective Study

Background In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. Methods We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. Results In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Conclusion Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.

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Prevalence and characteristics of headache attributed to ingestion or inhalation of a cold stimulus (HICS): A cross-sectional study

Cephalalgia ◽

10.1177/0333102419884938 ◽

2019 ◽

Vol 40 (3) ◽

pp. 299-306

Author(s):

Torsten Kraya ◽

Malte Schulz-Ehlbeck ◽

Philipp Burow ◽

Stefan Watzke ◽

Stephan Zierz

Keyword(s):

Rating Scale ◽

Primary Headache ◽

Tension Type Headache ◽

Primary Headaches ◽

Cross Sectional ◽

Cold Stimulus ◽

Clinical Criteria ◽

Number Of Patients ◽

Accompanying Symptoms ◽

Type Headache

Background Headache attributed to ingestion or inhalation of a cold stimulus (HICS), colloquially called ice-cream headache, is a common form of a primary headache in adults and children. However, previous studies on adults are limited due to the small number of patients. Furthermore, most of the subjects in previous studies had a history of other primary headaches. Methods Biographic data, clinical criteria of HICS and prevalence of primary headache were collected by a standardized questionnaire. A total of 1213 questionnaires were distributed; the return rate was 51.9% (n = 629); 618 questionnaires could be analyzed. Results In a cohort of 618 people aged between 17–63 years (females: n = 426, 68.9%), the prevalence of HICS was 51.3% (317 out of 618). There was no difference between men and women (51.3% vs. 51.6%). The duration of HICS was shorter than 30 sec in 92.7%. In the HICS group, localization of the pain was occipital in 17%. Trigemino-autonomic symptoms occurred in 22%, and visual phenomena (e.g. flickering lights, spots or lines) were reported by 18% of the HICS group. The pain intensity, but not the prevalence of HICS, was higher when tension-type headache and migraine or both were present as co-morbid primary headaches (Numeric Rating Scale (NRS) 4.58 and 6.54, p = 0.006). There was no higher risk of participants with migraine getting HICS than for those who did not have migraine (odds ratio = 1.17, 95% confidence interval (CI) 0.75–1.83; p = 0.496). Conclusion The results of this study modified the current criteria for HICS in the ICHD-3 regarding duration and localization. In addition, accompanying symptoms in about one fifth of the participants are not mentioned in the ICHD-3. Neither migraine nor tension-type headache seems to be a risk factor for HICS. However, accompanying symptoms in HICS are more frequent in subjects with another primary headache than in those without such a headache.

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A Population-Based Analysis of the Diagnostic Criteria of the International Headache Society

Cephalalgia ◽

10.1046/j.1468-2982.1991.1103129.x ◽

1991 ◽

Vol 11 (3) ◽

pp. 129-134 ◽

Cited By ~ 199

Author(s):

Birthe Krogh Rasmussen ◽

Rigmor Jensen ◽

Jes Olesen

Keyword(s):

Physical Activity ◽

Diagnostic Criteria ◽

International Headache Society ◽

Normal Subjects ◽

Population Based ◽

Tension Type Headache ◽

Headache Disorders ◽

Specific Proposal ◽

Accompanying Symptoms ◽

Type Headache

In 740 representative normal subjects a diagnostic headache interview and a neurological examination provided the necessary information to classify headache disorders according to the operational diagnostic criteria of the International Headache Society (IHS). Sixteen per cent (n = 119) had migraine, 78% (n = 578) tension-type headache. In migraineurs, pain was of a pulsating quality in 78%, severe in 85%, unilateral in 62%, and aggravated by routine physical activity in 96%. Tension-type headache was of a pressing quality in 78%, mild or moderate in 99%, bilateral in 90%, and 72% had no aggravation by physical activity. The accompanying symptoms of nausea, photo- and phonophobia occurred frequently and were usually moderate or severe in migraine subjects, and if present in subjects with tension-type headache, they were usually mild. Only two subjects had unclassifiable headache. The IHS Classification is thus exhaustive. The criteria may be improved by mandatory demands to the criterion of pain intensity leaving other features of pain as supportive for the diagnosis and by including graded severity of accompanying symptoms. A specific proposal is given.

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IHS Criteria and Gender: A Study on Migraine and Tension-Type Headache in Children and Adolescents

Cephalalgia ◽

10.1046/j.1468-2982.1996.1602107.x ◽

1996 ◽

Vol 16 (2) ◽

pp. 107-112 ◽

Cited By ~ 23

Author(s):

C Wöber-Bingöl ◽

C Wöber ◽

C Wagner-Ennsgraber ◽

K Zebenholzer ◽

C Vesely ◽

...

Keyword(s):

Physical Activity ◽

Children And Adolescents ◽

Diagnostic Criteria ◽

Migraine With Aura ◽

Outpatient Clinic ◽

Tension Type Headache ◽

Ihs Criteria ◽

Accompanying Symptoms ◽

And Gender ◽

Type Headache

The aim of this study was to investigate whether the IHS criteria for migraine and tension-type headache depend on gender. Among 409 children and adolescents with recurrent idiopathic headache seen at a university outpatient clinic, girls had significantly more often migraine with aura. Also, there was a trend towards a higher frequency of tension-type headache in girls. In migraine, aggravation of headache by physical activity and occurrence of aura symptoms were more common in females, whereas vomiting and phonophobia occurred more often in males. In tension-type headache, females more often reported mild intensity of headache. All other criteria were similar in both sexes. Age influenced the expression of some of the accompanying symptoms in the various types of migraine, but had only minimal influence on other diagnostic criteria of migraine and tension-type headache in females as well as in males. Our study suggests that the frequency of migraine (except that of migraine with aura) is similar among girls and boys, that tension-type headache may occur more often in girls, and that gender has some influence on the IHS criteria for migraine, but almost no influence on those of tension-type headache.

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Tension-type headache

Oxford Textbook of Headache Syndromes ◽

10.1093/med/9780198724322.003.0029 ◽

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.

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The modulating effect of bruxism as a form of suppressed hostility on depression in a selected population of tension type headache (ttha) and craniomandibular disorders (cmds) individuals. O efeito modulador do bruxismo como uma forma de hostilidade reprimida numa população seleta com dor de cabeça por tensão muscular e distúrbios craniomandibulares (dcms).

Cadernos UniFOA ◽

10.47385/cadunifoa.v6i15.1045 ◽

2017 ◽

Vol 6 (15) ◽

pp. 91

Author(s):

Omar Franklin Molina ◽

Marcus Sobreira Peixoto ◽

Raphael Navarro Aquilino ◽

Rise Rank

Keyword(s):

Beck Depression Inventory ◽

Facial Pain ◽

Positive Association ◽

Signs And Symptoms ◽

Tension Type Headache ◽

Craniomandibular Disorders ◽

Pain Group ◽

Craniomandibular Disorder ◽

History Of ◽

Type Headache

AIMS: explore the hypothesis that bruxism and depression are forms of suppressed hostility in individuals presenting Craniomandibular Disorders (CMDs) and Tension-type Headache (TTHa). METHODS: We evaluated a group of 100 Craniomandibular Disorders and Tension-Type Headache individuals, a group of 38 CMDs and Facial Pain individuals and a group of 23 No Craniomandibular Disorders No Facial Pain individuals. Clinical examination, questionnaires, history of signs and symptoms, the Beck Depression Inventory (BDI) and the Cook-Medley Inventory (HO) were used to gather data. RESULTS: The frequency of Tension Type Headache was about 43.5% in the group of 230 Craniomandibular Disorder patients. Mean scores in hostility were 19.0, 17.7 and 17.2 in the groups presenting Tension-Type Headache and CMDs, CMDs and Facial Pain and No CMDs no Pain, respectively. Mean scores in depression were about 12.0, 9.1 and 5.7 respectively in the same groups. Mean scores in bruxism were about 12.9, 8.2 and 6.8, respectively in the same groups. The strongest correlation between bruxism and depression were observed in the TTHa group (r=0.4, p<0.0001) and in the Non CMD Non Pain group (r=0.48, p<0.02). CONCLUSION: Depression is a better indicator of hostility in subgroups presenting TTHa. Scores in bruxism and depression as a form of suppressed hostility are higher in CMDs and TTHa individuals than in controls without TTHa. Because scores in bruxism were higher in TTHa and CMDs individuals, there is a strong and positive association between bruxism and TTHa in individuals with concomitant Craniomandibular disorders.

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The modulating effect of bruxism as a form of suppressed hostility on depression in a selected population of tension type headache (ttha) and craniomandibular disorders (cmds) individuals

Cadernos UniFOA ◽

10.47385/cadunifoa.v6.n15.1045 ◽

2017 ◽

Vol 6 (15) ◽

pp. 91-100

Author(s):

Omar Franklin Molina ◽

Marcus Sobreira Peixoto ◽

Raphael Navarro Aquilino ◽

Rise Rank

Keyword(s):

Beck Depression Inventory ◽

Facial Pain ◽

Positive Association ◽

Signs And Symptoms ◽

Tension Type Headache ◽

Craniomandibular Disorders ◽

Pain Group ◽

Craniomandibular Disorder ◽

History Of ◽

Type Headache

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Prevalence of headache attributed to aeroplane travel in headache outpatient populations: An Italian multicentric survey

Cephalalgia ◽

10.1177/0333102419843676 ◽

2019 ◽

Vol 39 (10) ◽

pp. 1219-1225 ◽

Cited By ~ 1

Author(s):

Federico Mainardi ◽

Ferdinando Maggioni ◽

Giorgio Dalla Volta ◽

Marco Trucco ◽

Grazia Sances ◽

...

Keyword(s):

Migraine Without Aura ◽

Epidemiological Data ◽

Tension Type Headache ◽

Conjunctival Injection ◽

Flight Experience ◽

Severe Intensity ◽

Accompanying Symptoms ◽

Type Headache ◽

Headache Centres ◽

Detailed Questionnaire

Background To assess the prevalence of headache attributed to aeroplane travel (AH) in patients referred to Italian Headache Centres. Material and method 869 consecutive patients visiting six Italian headache centres during a 6 month-period (October 2013 to March 2014) were enrolled in the survey. Among them, 136 (15.6%) had never flown and therefore were excluded from the study. The remaining 733 patients (f = 586, m = 147; age 39.1 ± 17.3) were asked about the occurrence of headache attacks during flight; those who answered the question positively filled in a detailed questionnaire that allowed the features of the attacks to be defined. Results Headache attacks during the flight was reported by 34/733 subjects; four presented attacks fulfilling ICHD-3 beta (1) criteria for migraine without aura and therefore were not further considered. The features of the remaining 30 (4.0%; m = 18, f = 12, age 36.4 ± 7.3) completely fulfilled the ICHD-3 beta criteria for AH. In more detail, the pain was unilateral (fronto-orbital: n = 23; fronto-parietal: n = 7; without side-shift: n = 25, with side-shift: n = 5), lasting up to 30 min in 29 subjects. All the patients reported the pain as very severe or unbearable and landing as the phase of travel in which the attack appeared. In four cases, a postictal, milder, dull headache could last up to 24 hours. Accompanying symptoms were present in eight cases (restlessness: n = 5; conjunctival injection and tearing: n = 2; restlessness + ipsilateral conjunctival injection and tearing: n = 1). The fear of experiencing further attacks negatively affected the propensity for future flights in 90.0% of subjects (n = 27). In all the patients, AH onset did not coincide with the first flight experience. Concomitant migraine without aura was diagnosed in 24, tension-type headache in four, migraine without aura + tension-type headache in two cases; none suffered from cluster headache. Five subjects reported AH on each flight, 20 in > 50% of flights, five occasionally. Despite the severe intensity of the pain, only one third of this sample spontaneously reverted to a pharmacological treatment; the most useful strategy combines a decongestant nasal spray plus the intake of a simple analgesic 30 min before the estimated attack. Spontaneous manoeuvres were applied by 18 patients (Valsalva-like: n = 12; compression: n = 2; both manoeuvres: n = 4), more often without significant improvement. These data confirm our previous finding on the clinical features of AH. Conclusion AH was found in 4.0% of a multicentre, large sample of patients with flight experiences. Although limited to a sample of patients followed in six Italian headache centres, to the best of our knowledge these are the first epidemiological data on AH gathered by direct interview. If properly investigated, AH seems to be a not infrequent condition, which, when diagnosed, could probably be prevented in many cases.

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