Neuroimaging in Outpatients with Tension Type Headache

Background: Research into the role of neuroimaging in primary headaches such as tension type headache (TTH) is ongoing. In the present study, we aim to evaluate the ability of neuroimaging to detect potential abnormalities in patients with new onset TTH and normal neurological exam. Materials and Methods: In a prospective study, 294 cases of new onset TTH with normal neurological exam, that had neuroimaging, were selected. Imaging was evaluated for significant abnormalities. The percentage of abnormal findings in imaging was calculated. Results: 64(21.8%) patients had MRI. Of them, 21.8% of MRIs revealed abnormal findings. Meanwhile, from 238 CTs, only 0.4% showed abnormalities. Conclusion: Neuroimaging with current quality does not play an important role in management of patients with new onset TTH and normal neurological exam. [GMJ.2015;4(2):62-66]

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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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A Prospective Study of the Headache Phase in 32 Migraine with Aura Patients

Cephalalgia ◽

10.1046/j.1468-2982.2002.00388.x ◽

2002 ◽

Vol 22 (6) ◽

pp. 411-415 ◽

Cited By ~ 9

Author(s):

D Cologno ◽

P Torelli ◽

GC Manzoni

Keyword(s):

Prospective Study ◽

Clinical Features ◽

Migraine With Aura ◽

International Headache Society ◽

Case Series ◽

Tension Type Headache ◽

Pain Location ◽

Headache Centre ◽

Type Headache ◽

A Prospective Study

For an accurate description of the clinical features of the headache phase in migraine with aura (MA) attacks, we thought it useful to conduct a prospective study of consecutively referred MA patients seeking treatment at the Headache Centre of the University of Parma Institute of Neurology. The case series included 32 patients (22 women and 10 men). At the time of the first visit, each patient was given a questionnaire to be filled in at the next MA attack. Six patients (four women and two men) had attacks of migraine aura without headache. Among the remaining 26 patients (18 women and eight men), the duration of the headache phase was < 24 h in 23 (88.5%); pain location was bilateral in 14 (53.8%) and unilateral in 12, but occurring on the opposite side to aura only in one patient; pain intensity was mild or moderate in 13 (50.0%). The headache phase of MA appeared to have clinical features that differed widely from patient to patient and was consistent with the International Headache Society diagnostic criteria for migraine without aura in 26.9% of patients and for tension-type headache (TTH) in 23.1%.

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Crying as a precipitating factor for migraine and tension-type headache

Sao Paulo Medical Journal ◽

10.1590/s1516-31802003000100008 ◽

2003 ◽

Vol 121 (1) ◽

pp. 31-33 ◽

Cited By ~ 4

Author(s):

Yara Dadalti Fragoso ◽

Regina Carvalho ◽

Fernanda Ferrero ◽

Darcya Maria Lourenço ◽

Erica Regina Paulino

Keyword(s):

Daily Practice ◽

Tension Type Headache ◽

Primary Headaches ◽

Precipitating Factors ◽

Headache Type ◽

Potential Factor ◽

Type Headache ◽

One Year ◽

Precipitating Factor

CONTEXT: Scarcely reported in the literature, crying seems to be an important precipitating factor for both migraine and tension-type headache in daily practice. OBJECTIVE: To evaluate the role of crying as a precipitating factor for migraine and tension-type headache. TYPE OF STUDY: Prospective evaluation. PARTICIPANTS: 163 workers or students from the Universidade Metropolitana de Santos, who presented at least one attack a month, for at least one year, of either migraine or tension-type headache. PROCEDURES: Interview by means of questionnaires and personal evaluations. Details of precipitating factors for the attacks were assessed. RESULTS: From the total group of 163 individuals, 90 (55.2%) considered crying to be a potential factor for triggering headache attacks. Of this group of 90 persons, 62 presented migraine (6 males, 56 females) and 28 presented tension-type headache (5 males, 23 females). Only stress, anxiety and menstrual periods rated higher or equal to crying as triggering factors for both types of headache. CONCLUSIONS: The physiology of crying is not well documented or understood. The act of crying seems to be an important precipitating factor for primary headaches and it should be studied further. The authors welcome comments on the matter and would like to work in collaboration with other groups interested in this subject.

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Immunological findings in patients with migraine and other primary headaches: a narrative review

Clinical & Experimental Immunology ◽

10.1093/cei/uxab025 ◽

2021 ◽

Author(s):

Leonardo Biscetti ◽

Gioacchino De Vanna ◽

Elena Cresta ◽

Alessia Bellotti ◽

Ilenia Corbelli ◽

...

Keyword(s):

Lymphocyte Subsets ◽

Human Leukocyte ◽

Tension Type Headache ◽

Primary Headaches ◽

Leukocyte Antigen ◽

Type Headache ◽

Experimental Findings ◽

Headache Patients ◽

Pro Inflammatory Cytokines

Abstract Experimental findings suggest an involvement of neuroinflammatory mechanisms in the pathophysiology of migraine. Specifically, preclinical models of migraine have emphasized the role of neuroinflammation following the activation of the trigeminal pathway at several peripheral and central sites including dural vessels, the trigeminal ganglion and the trigeminal nucleus caudalis. The evidence of an induction of inflammatory events in migraine pathophysiological mechanisms has prompted researchers to investigate the Human leukocyte antigen (HLA) phenotypes as well as cytokine genetic polymorphisms in order to verify their potential relationship with migraine risk and severity. Furthermore, the role of neuroinflammation in migraine seems to be supported by evidence of an increase in pro-inflammatory cytokines, both ictally and interictally, together with the prevalence of Th1 lymphocytes and a reduction in regulatory lymphocyte subsets in peripheral blood of migraineurs. Cytokine profiles of cluster headache patients and those of tension-type headache patients further suggest an immunological dysregulation in the pathophysiology of these primary headaches, although evidence is weaker than for migraine. The present review summarizes available findings to date from genetic and biomarker studies that have explored the role of inflammation in primary headaches.

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CGRP in human models of primary headaches

Cephalalgia ◽

10.1177/0333102416684344 ◽

2016 ◽

Vol 38 (2) ◽

pp. 353-360 ◽

Cited By ~ 7

Author(s):

Håkan Ashina ◽

Henrik Winther Schytz ◽

Messoud Ashina

Keyword(s):

Treatment Strategies ◽

Primary Headache ◽

Experimental Models ◽

Tension Type Headache ◽

Primary Headaches ◽

Human Models ◽

New Treatment ◽

Type Headache ◽

Methodological Aspects

Objective To review the role of CGRP in human models of primary headaches and to discuss methodological aspects and future directions. Discussion Provocation experiments demonstrated a heterogeneous CGRP migraine response in migraine patients. Conflicting CGRP plasma results in the provocation experiments are likely due to assay variation; therefore, proper validation and standardization of an assay is needed. To what extent CGRP is involved in tension-type headache and cluster headache is unknown. Conclusion Human models of primary headaches have elucidated the role of CGRP in headache pathophysiology and sparked great interest in developing new treatment strategies using CGRP antagonists and antibodies. Future studies applying more refined human experimental models should identify biomarkers of CGRP-induced primary headache and reveal whether CGRP provocation experiments could be used to predict efficacy of CGRP antagonists in migraine patients.

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

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736644077.793567837 ◽

2019 ◽

Author(s):

Mario Peres

Keyword(s):

Prospective Study ◽

Tension Type Headache ◽

Large Series ◽

Type Headache ◽

A Prospective Study

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Prevalence of Primary Headaches in People with Multiple Sclerosis

Cephalalgia ◽

10.1111/j.1468-2982.2004.00790.x ◽

2004 ◽

Vol 24 (11) ◽

pp. 980-984 ◽

Cited By ~ 68

Author(s):

D D'Amico ◽

L La Mantia ◽

A Rigamonti ◽

S Usai ◽

N Mascoli ◽

...

Keyword(s):

Multiple Sclerosis ◽

International Headache Society ◽

Primary Headache ◽

Tension Type Headache ◽

Primary Headaches ◽

Exact Test ◽

Relapsing Remitting ◽

Type Headache ◽

Ms Therapy

The aim was to investigate the lifetime prevalence of headache and primary headache (diagnoses according to International Headache Society criteria) in multiple sclerosis (MS). The relationships between headache and clinical features of MS and MS therapy were also investigated. We studied 137 patients with clinically definite MS; 88 reported headache, 21 of whom developed headache after the initiation of interferon. The prevalence of all headaches in the remaining 116 patients was 57.7%. Migraine was found in 25.0%, tension-type headache in 31.9%, and cluster headache in one patient. A significant correlation ( P = 0.007, Fisher's exact test) between migraine and relapsing-remitting MS was found. Primary headaches are common in MS patients. Further studies are needed to clarify the mechanisms underlying this association, particularly the association between migraine and relapsing-remitting MS, and the role of interferon in the development of new headache.

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Calcitonin Gene-Related Peptide in Tension-Type Headache

The Scientific World JOURNAL ◽

10.1100/tsw.2002.808 ◽

2002 ◽

Vol 2 ◽

pp. 1527-1531 ◽

Cited By ~ 3

Author(s):

M. Ashina

Keyword(s):

Plasma Levels ◽

Calcitonin Gene Related Peptide ◽

Tension Type Headache ◽

Nerve Fibers ◽

Primary Headaches ◽

Chronic Tension Type Headache ◽

Related Peptide ◽

Calcitonin Gene ◽

Type Headache

In the last 10 years there has been increasing interest in the role of calcitonin gene-related peptide (CGRP) in primary headaches. Tension-type headache is one of the most common and important types of primary headaches, and ongoing nociception from myofascial tissues may play an important role in the pathophysiology of this disorder. CGRP sensory fibers are preferentially located in the walls of arteries, and nerve fibers containing CGRP accompany small blood vessels in human cranial muscles. It is well established that nociception may lead to release of CGRP from sensory nerve endings and from central terminals of sensory afferents into the spinal cord. It has also been shown that density of CGRP fibers around arteries is increased in persistently inflamed muscle. These findings indicate that ongoing activity in sensory neurons in the cranial muscles may be reflected in changes of plasma levels of neuropeptides in patients with chronic tension-type headache. To explore the possible role of CGRP in tension-type headache, plasma levels of CGRP were measured in patients with chronic tension-type headache. This study showed that plasma levels of CGRP are normal in patients and unrelated to headache state. However, the findings of normal plasma levels of CGRP do not exclude the possibility that abnormalities of this neuropeptide at the neuronal or peripheral (pericranial muscles) levels play a role in the pathophysiology of tension-type headache. Investigation of CGRP in other compartments with new sensitive methods of analysis is necessary to clarify its role in tension-type headache.

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