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A randomized control trial was conducted to assess the effectiveness of progressive muscle relaxation and deep breathing exercises on pain, disability, and sleep quality among patients with chronic tension-type headache. Of the 169 randomly selected patients, 84 performed the intervention and reported less pain severity and disability and better sleep quality after 12 weeks. [ABSTRACT FROM AUTHOR]

Objective: To explore the demographic and disease-related factors associated with acupuncture response in patients with chronic tension-type headache (CTTH). Methods: Using data from a randomized clinical trial (218 cases) consisting of 4 weeks of baseline assessment, 8 weeks of treatment, and 24 weeks of follow-up, participants were regrouped into responders (at least a 50% reduction in monthly headache days at week 16 compared with baseline) and non-responders. Twenty-three demographic and disease-related factors associated with acupuncture response in 183 participants were analyzed by multivariable logistic regression. Results: One hundred and nineteen (65.0%) participants were classified as responders. Four factors were significantly independently associated with acupuncture response, including treatment assignment, headache intensity at baseline, and 2 domains [general health (GH) and social functioning (SF)] from the 36-Item Short Form Health Survey quality of life questionnaire. Treatment assignment was associated with non-response: participants receiving true acupuncture were 3-time more likely to achieve a CTTH response than those receiving superficial acupuncture [odds ratio (OR) 0.322, 95% confidence interval (CI) 0.162 to 0.625, P=0.001]. Compared with patients with mild-intensity headache, patients with moderate-intensity headache were twice as likely to respond to acupuncture (OR 2.001, 95% CI 1.020 to 4.011, P=0.046). The likelihood of non-response increased by 4.5% with each unit increase in the GH grade (OR 0.955, 95% CI 0.917 to 0.993, P=0.024) while decreased by 3.8% with each unit increase in the SF grade (OR 1.038, 95% CI 1.009 to 1.069, P=0.011). Conclusions: Greater headache intensity, lower GH score, and higher SF score were associated with better acupuncture responses in CTTH patients. These 3 factors require independent validation as predictors of acupuncture effectiveness in CTTH. [ABSTRACT FROM AUTHOR]

Background: Current literature extensively covers the use of sphenopalatine ganglion stimulation (SPGs) in treating a broad spectrum of medical conditions, such as allergic rhinitis, cluster headaches, and strokes. Nevertheless, a discernible gap in the systematic organization and analysis of these studies is evident. This paper aims to bridge this gap by conducting a comprehensive review and analysis of existing literature on SPGs across various medical conditions. Methods: This study meticulously constructed a comprehensive database through systematic computerized searches conducted on PubMed, Embase, CNKI, Wanfang, VIP, and CBM up to May 2022. The inclusion criteria encompassed randomized controlled trials (RCTs) published in either Chinese or English, focusing on the therapeutic applications of SPGs for various medical conditions. Both qualitative and quantitative outcome indicators were considered eligible for inclusion. Results: This comprehensive study reviewed 36 publications, comprising 10 high-quality, 23 medium-quality, and three low-quality articles. The study investigated various diseases, including allergic rhinitis (AR), ischemic strokes (IS), cluster headache (CH), primary trigeminal neuralgia (PTN), pediatric chronic secretory otitis (PCSO), refractory facial paralysis (RFP), chronic tension-type headache (CTTH), as well as the analysis of low-frequency sphenopalatine ganglion stimulation (LF-SPGs) in chronic cluster headache (CCH) and the impact of SPGs on Normal nasal cavity function (NNCF). SPGs demonstrate efficacy in the treatment of AR. Regarding the improvement of rhinoconjunctivitis quality of life questionnaire (RQLQ) scores, SPGs are considered the optimal intervention according to the SUCRA ranking. Concerning the improvement in Total Nasal Symptom Score (TNSS), Conventional Acupuncture Combined with Tradiational Chinese Medicine (CA-TCM) holds a significant advantage in the SUCRA ranking and is deemed the best intervention. In terms of increasing Effective Rate (ER), SPGs outperformed both conventional acupuncture (CA) and Western Medicine (WM; P < 0.05). In the context of SPGs treatment for IS, the results indicate a significant improvement in the 3-month outcomes, as evaluated by the modified Rankin Scale (mRS) in the context of Cerebral Cortical Infarction (CCI; P < 0.05). In the treatment of CH with SPGs, the treatment has been shown to have a statistically significant effect on the relief and disappearance of headaches (P < 0.05). The impact of SPGs on NNCF reveals statistically significant improvements (P < 0.05) in nasal airway resistance (NAR), nasal cavity volume (NCV), exhaled nitric oxide (eNO), substance P (SP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY). SPGs treatments for PCSO, RFP, and CTTH, when compared to control groups, yielded statistically significant results (P < 0.05). Conclusion: SPGs demonstrate significant effectiveness in the treatment of AR, IS, and CH. Effective management of CCH may require addressing both autonomic dysregulation and deeper neural pathways. However, additional high-quality research is essential to clarify its effects on NNCF, PTN, PCSO, RFP, and CTTH. [ABSTRACT FROM AUTHOR]

Background: Autonomic function tests can be used by patients with chronic migraine and chronic tension-type headaches (TTH) as a non-invasive, sensitive, and reliable marker for evaluating heart function. Studies have demonstrated sympathetic and parasympathetic dysfunction. Patients with migraines experience sympathetic and parasympathetic nervous system hyperfunction, while tension headache sufferers experience the opposite. Aims and Objectives: Parasympathetic reactivity tests will be used in the current study to evaluate the cardiac autonomic functioning in patients with chronic migraine and chronic TTH in the adult age group. Materials and Methods: Two groups of headache patients were enrolled: Those with chronic migraine (n=25) and those with chronic TTH (n=25). To conduct statistical analyses, SPSS version 21 was used. For parameters with normal and abnormal distributions, the unpaired t-test and Mann–Whitney U-test, respectively, were employed. Results: Out of 25 subjects, parasympathetic reactivity tests such as Valsalva ratio (1.38±0.10 vs. 1.49±0.19, P=0.022*) and expiratory-inspiratory ratio (1.18±0.03 vs. 1.25±0.77, P=0.000*) in chronic migraine were significantly decreased as compared to chronic TTH. Lying to standing 30:15 ratio (1.15±0.08 vs. 1.19±0.10, P=0.090) and delta heart rate (14.56±1.39 vs. 14.96±1.43, P=0.320) was decreased in chronic migraine as compared to chronic TTH but was not significant. Conclusions: In contrast to the chronic TTH group, the chronic migraine group’s total parasympathetic tone was reduced. We therefore draw the conclusion from the findings that regular monitoring of the parasympathetic reactivity can be very helpful in predicting cardiovascular risk for these patients in addition to advising the treatment practices for chronic migraine and chronic TTH, which include regular exercise and medication.

Background: Autonomic function tests can be used by patients with chronic migraine and chronic tension-type headaches (TTH) as a non-invasive, sensitive, and reliable marker for evaluating heart function. Studies have demonstrated sympathetic and parasympathetic dysfunction. Patients with migraines experience sympathetic and parasympathetic nervous system hyperfunction, while tension headache sufferers experience the opposite. Aims and Objectives: Parasympathetic reactivity tests will be used in the current study to evaluate the cardiac autonomic functioning in patients with chronic migraine and chronic TTH in the adult age group. Materials and Methods: Two groups of headache patients were enrolled: Those with chronic migraine (n=25) and those with chronic TTH (n=25). To conduct statistical analyses, SPSS version 21 was used. For parameters with normal and abnormal distributions, the unpaired t-test and Mann-Whitney U-test, respectively, were employed. Results: Out of 25 subjects, parasympathetic reactivity tests such as Valsalva ratio (1.38±0.10 vs. 1.49±0.19, P=0.022*) and expiratory-inspiratory ratio (1.18±0.03 vs. 1.25±0.77, P=0.000*) in chronic migraine were significantly decreased as compared to chronic TTH. Lying to standing 30:15 ratio (1.15±0.08 vs. 1.19±0.10, P=0.090) and delta heart rate (14.56±1.39 vs. 14.96±1.43, P=0.320) was decreased in chronic migraine as compared to chronic TTH but was not significant. Conclusions: In contrast to the chronic TTH group, the chronic migraine group's total parasympathetic tone was reduced. We therefore draw the conclusion from the findings that regular monitoring of the parasympathetic reactivity can be very helpful in predicting cardiovascular risk for these patients in addition to advising the treatment practices for chronic migraine and chronic TTH, which include regular exercise and medication. [ABSTRACT FROM AUTHOR]

Background: Tension headache is the most common type of headache. Objective: The purpose of this study was to investigate the effect of aerobic exercise and herbal capsules on serotonin levels and headache indices in women suffering from chronic tension-type headache (CTTH). Methods: In this practical study, 18 adult female patients with CTTH were randomly divided into two equal groups: exercise and herbal capsule. Aerobic training was performed three sessions a week, each session lasting 75 minutes for eight week. The herbal capsule contained the hydro-alcoholic extract of Valeriana jatamansi and Melissa officinalis. Each capsule contained 280 mg of these two herbs, which the patients consumed three times a day. Serotonin levels, headache indices (intensity, duration, and frequency of headache), anxiety, depression, use of synthetic drugs, and aerobic capacity were evaluated at baseline and at the end of the study. Results: According to the results within the group, in both groups there was a significant increase in serotonin, aerobic capacity (only in the exercise group) and a significant decrease in anxiety, depression, headache intensity, headache frequency, headache duration (only in the exercise group) and the use of synthetic drugs. In the comparison between groups, a significant difference was observed in the intensity and frequency of headache, use of synthetic drugs, aerobic capacity and anxiety. Conclusion: Aerobic exercise and hydro-alcoholic extract of Valeriana jatamansi and Melissa officinalis plants can be a suitable treatment supplement for women suffering from CTTH but the effect of two plants was better in improving headache.

Background: Chronic daily headache (CDH) is a headache that lasts at least 15 days, 3 months, and 4 hours a day without treatment. Transcranial Magnetic Stimulation (TMS) uses short magnetic pulses over the head to temporarily alter brain cortical excitability. Prefrontal cortex rTMS has shown analgesic benefits. Objective: The purpose of the current study was to assess the effectiveness of repetitive transcranial magnetic stimulation in the management of chronic daily headache patients. Patients and Methods: A clinical trial was conducted in the period from July 2022 to December 2022 A total of 40 patients participated in the study. All patients were monitored at the Neurology Department of Al-Azhar University Hospital, New Damitta. A total of 25 patients made up the experimental group, which received genuine (5 Hz) rTMS, while 15 patients made up the control group received phoney (5 Hz) rTMS. Results: There were no statistically significant differences between the intervention and control groups in terms of age, sex, BMI, headache frequency, or duration. Prior to treatment, the intervention and control groups had comparable incidence and indices of headache. Following therapy, compared to the control group, the intervention group's headache frequency and index considerably decreased. The severity of the headaches before treatment was similar between the intervention and control groups. Following therapy, the intervention group's headache severity dramatically decreased as compared to the control group. Conclusion: Patients whom suffer from chronic migraines and tension headaches may be effectively treated and prevented using high-frequency rTMS. In light of this, it is advised that patients with chronic daily headaches, especially those who are not responding to therapy, consider high-frequency rTMS as a potential treatment. [ABSTRACT FROM AUTHOR]

There is a growing body of evidence linking hypovitaminosis D with the prevalence and severity of various pain conditions. The effect of vitamin D levels on chronic tension type headache (CTTH) is almost unexplored.Objective: to investigate the effect of serum vitamin D levels on the clinical characteristics of CTTH.Patients and methods. The study enrolled women with CTTH (n=161). Headache frequency (HF), headache duration (HD), headache intensity (HI), presence of chronic widespread pain (WP) and the number of its zones, severity of anxiety and depression, and sleep quality index were evaluated. The vitamin D level was assessed by the concentration of 25-hydroxyvitamin D [25(OH)D].Results and discussion. Low 25(ОН)D-level was associated with an increase in HF, HD and the prevalence of WP. For each of the listed parameters, the values in vitamin D deficiency were higher than in its insufficiency or normal ranges (p

The Russian experts’ guidelines on evaluation and treatment of medication-overuse headache are based on evidence-based medicine, the latest revision of the International Classification of Headache Disorders. Basic information about epidemiology, risk factors, pathophysiological mechanisms, evaluation, and the most effective pharmacological drug and non-pharmacological approaches to managing patients with medication-overuse headache are presented.

Background: Chronic tension-type headache (CTTH) is frequently associated with a psychiatric comorbidity of depression and anxiety. Most studies focus their attention on this association, and only few link CTTH with psycho-affective emotional regulation disorders. Objective: To evaluate the association of CTTH with anxiety, depression, positive and negative affectivity, and emotional management in CTTH patients with neither a previous diagnosis of psychiatric disorder nor use of psychoactive drugs or abuse of analgesics. Design: Case-control study. Methods: Validated scores for state and trait anxiety, depression, positive and negative state and trait affect, cognitive reappraisal, and expressive suppression were assessed in 40 subjects with CTTH and 40 healthy subjects. Associations between CTTH and psychological status were assessed through linear multivariate regression models. Results: CTTH was associated with higher scores for depression (Beta = 5.46, 95% CI: 1.04–9.88), state and trait anxiety (Beta = 12.77, 95% CI: 4.99–20.56 and Beta = 8.79, 95% CI: 2.29–15.30, respectively), and negative state affect (Beta = 5.26, 95% CI: 0.88–9.64). Conclusions: CTTH is directly associated with depression, anxiety, and negative affectivity signs despite the absence of a previously diagnosed psychiatric disorder or psychopharmacological intake. The recognition of these comorbid and psycho-affective disorders is essential to adapt the emotional management of these patients for better control. [ABSTRACT FROM AUTHOR]

Chronic tension-type headache (CTTH) is a common disease with no fully defined pathophysiological processes. We designed a study to value electrophysiological responses in these patients and their correlation with possible psychopathological manifestations in order to deepen understanding of central and peripheral mechanisms of CTTH. In 40 patients with CTTH and 40 healthy controls, we used electrical stimulation to determine sensory threshold (SPT) and pain perception threshold (PPT) and the characteristics of the electrophysiological sensory nerve action potential (SNAP): initial sensory response (ISR) and supramaximal response (SMR). We then calculated the intensity differences between thresholds (IDT), namely SPT-PPT, ISR-SMR and SMR-PPT, and correlated these IDTs with psychological characteristics: trait and state anxiety, depression, and emotional regulation. The SPT, together with the ISR and SMR thresholds, were higher (p < 0.01) in CTTH patients. The SMR-PPT IDT was smaller and correlated with significantly higher indicators of depression, state and trait anxiety, and poorer cognitive reappraisal. CTTH patients have less capacity to recognize non-nociceptive sensory stimuli, greater tendency toward pain facilitation, and a poor central pain control requiring higher stimulation intensity thresholds to reach the start and the peak amplitude of the SNAP. This is consistent with relative hypoexcitability of the Aβ nerve fibers in distant regions from the site of pain, and therefore, it could be considered a generalized dysfunction with a focal expression. Pain facilitation is directly associated with psychological comorbidity. [ABSTRACT FROM AUTHOR]

New daily persistent headache is described as an enigmatic condition with daily headache from onset. It has posed challenges diagnostically and therapeutically. Methods: We conducted a study of patients referred to headache services based in Central and North-East London, United Kingdom, meeting the International Classificaiton of Headache Disorders – 3 criteria for New daily persistent headache. Information on demographics, phenotype and treatment responses were collected. The syndrome of the daily headache was also classified according any other ICHD-3-defined syndrome. Results: Of 162 patients, females comprised 68.5% with median age of onset 35 years. The daily headache experienced was chronic migraine in 89.7% and tension-type headache in 8.8%. Thunderclap-onset New daily persistent headache occurred in 14.8%. More than one headache syndrome was experienced in 15.4%, including cough, hypnic, sexual and stabbing headache. All aura types were experienced, most commonly brainstem aura in 39%. Prior headache was reported 53.7%. A persisting sub-form was present in 51.2%, relapsing remitting in 12.3% and 14.0% reported improvement; 19.8% were lost to follow-up. Only 11.1% reported an antecedent trigger. The most common premorbid disorders were psychiatric in 35.7%. A fifth improved on preventative medication, most commonly amitriptyline, propranolol and topiramate. Conclusion: Our cohort of New daily persistent headache is consistent with a mode of onset of migraine and tension-type headache which occurs in predisposed individuals. [ABSTRACT FROM AUTHOR]

Objectives: Chronic tension-type headache (TTH) is a serious disease that disrupts quality of life. In this study, the effect of prophylactic oral melatonin treatment on headache and cerebral vasomotor reactivity (VMR) was investigated in patients diagnosed with chronic TTH per the International Classification of Headache Disorders criteria. Subjects and Methods: Twenty patients with chronic TTH and 20 healthy individuals were included in the study. The patients were administered a melatonin treatment at 3 mg/day for 12 weeks. The number of monthly painful days and pain severity were recorded with the “Visual Analog Scale” before and after the treatment. Cerebral VMR measurements were performed at baseline in the control group and in patients before and after the treatment. Results: The median number of monthly painful days was 20 (15–27) before the treatment and 10 (4–18) after the treatment; the median pain severity score was 70.00 (45–80) before the treatment and 42.50 (15–75) after the treatment. The difference was statistically significant (P = 0.001). No statistically significant difference between the VMR values was observed (P > 0.05). Conclusions: Melatonin treatment was effective in reducing the pain severity and decreasing the number of monthly painful days in patients with chronic TTH but demonstrated no effect on the cerebral VMR.

Abstract Background Tension-type headache is the most common headache to be seen in clinical practice. Depression is highly prevalent in chronic tension-type headache (CTTH) patients attending the clinical settings. Cognitive impairment and neuroendocrine dysregulation had been reported in patients with depression and patients with CTTH. Objective To assess the cognitive performance and investigate its possible relations to neuroendocrine levels in patients with CTTH. Subjects and methods Patients with CTTH, depression, and control subjects were recruited. CTTH was diagnosed according to the International Classification of Headache Disorders. Cognitive performance, depression severity, and pain intensity were assessed by the Montreal Cognitive Assessment Arabic version, Beck’s Depression Inventory, and McGill Pain Questionnaire respectively. Blood samples were collected in the morning within 60 min after waking up from 8:00 to 9:00 a.m. to measure serum levels of basal plasma CRH, ACTH, Cortisol, TSH, FT3, and FT4. Results Both patients with CTTH and depression had impaired cognitive performance. Patients with CTTH and patients with depression had altered the hypothalamus-pituitary-adrenal axis, and pituitary-thyroid axis. The hormonal levels significantly correlated with cognitive function in patient groups, especially patients with CTTH. Conclusion Patients with CTTH had cognitive dysfunction which could be related to neuroendocrine hormonal dysregulation.

The pathogeneses of chronic tension-type headache (CTTH) and cervicogenic headache (CEH) are not well established. Peripheral activation or sensitization of myofascial nociceptors is suggested as a potential mechanism and injections of botulinum toxin (BONTA) have thus been used in the treatment for both headache conditions. BONTA inhibits the release of acetylcholine at the neuromuscular junction and inhibits contraction of skeletal muscles. If the pain is precipitated by increased tone in cervical muscles, local injections of BONTA could represent a prophylactic measure. However, the treatment is still controversial, and a thorough assessment of the current evidence is required. This review aims to assess the evidence of BONTA injection as a prophylactic treatment for CTTH and CEH by reviewing and examining the quality of placebo-controlled, randomized trials. Data sources: we searched in the following databases: PubMed (including Medline), Embase, Cochrane Central register of Controlled Trials, Cinahl, Amed, SCOPUS and Google Scholar including other repository sources. Both MeSH and free keywords were used in conducting the systematic search in the databases. The search covered publications from the root of the databases to November 2020. The review included RCTs, comparing single treatment of BONTA with placebo on patients with CTTH or CEH above 18 years of age, by measuring pain severity/relief or headache frequency. The following data were extracted: year of publication, country, setting, trial design, number of participants, injection procedure, BONTA dosages, and clinical outcome measures. To assess validity and quality, and risk of bias, the Oxford Pain Validity Scale, Modified Jadad Scale, last version of Cochrane Collaboration's tool for assessing risk of bias (RoB 2), and the CONSORT 2010 Checklist were used. The trials were assessed, and quality scored independently by two of the reviewers. A quantitative synthesis and meta-analyses of headache frequency and intensity were performed. We extracted 16 trials, 12 on prophylactic BONTA treatment for CTTH and four on CEH. Of these 12 trials (8 on CTTH and 4 on CEH) were included in the quantitative synthesis. A majority of the trials found no significant difference on the primary outcome measure when BONTA treatment was compared with placebo. Three "positive" trials, reporting significant difference in favor of BONTA treatment, but two of these were hampered by low validity and quality scores and high risk of bias. There is no clear clinical evidence supporting prophylactic treatment with BONTA for CTTH or CEH. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to evaluate the feasibility and efficacy of a complex health intervention, based on the combination of conventional Western medicine and traditional Chinese medicine (TCM), in an outpatient department of a university hospital for patients with frequent episodic or chronic tension-type headaches. Methods/design This is a prospective randomized controlled pilot study with four balanced treatment arms (usual care, acupuncture, training, and training plus acupuncture). Each arm will have 24 patients. After the initial screening examination and randomization, a 6-week treatment period follows, with treatment frequencies decreasing at 2-week intervals. After completion of the intervention, two follow-up evaluations will be performed 3 and 6 months after the start of treatment. At predefined times, the various outcomes (pain intensity, health-related quality of life, pain duration, autonomic regulation, and heart rate variability) as well as the participants’ acceptance of the complex treatment will be evaluated with valid assessment instruments (Migraine Disability Assessment, PHQ-D, GAD-7, and SF-12) and a headache diary. The acupuncture treatment will be based on the rules of TCM, comprising a standardized combination of acupuncture points and additional points selected according to individual pain localization. The training therapy comprises a combination of strength training, endurance training, and training to improve flexibility and coordination. Besides descriptive analyses of the samples, their comparability will be assessed using an analysis of variance (ANOVA) or chi-squared tests. Analyses will be performed on an intention-to-treat basis. Potential interaction effects will be calculated using a repeated-measures ANOVA to test the primary and secondary hypotheses. In supplementary analyses, the proportion of treatment responders (those with a 50% reduction in the frequency of pain episodes) will be determined for each treatment arm. Discussion This trial may provide evidence for the additive effects of acupuncture and medical training therapy as a combination treatment and may scientifically support the implementation of this complex health intervention. Trial registration Registered on 11 Feburary 2019. German Clinical Trials Register, DRKS00016723.

Background & Objectives: Chronic tension-type headache (CTTH) is a disabling disorder that can cause considerable pain and negative impact on the individual’s health. We compared the efficacy of trigger point self-massage to standard drug treatment in patients with CTTH. Methods: This was a randomized study with an active comparator on CTTH patients. Eighty participants were randomized to an intervention or comparator group. Participants in the comparator group received tablet nortriptyline 10 mg daily and the participants in the intervention group were treated with trigger point self-massage at 8 different points 3 times a day for 4 weeks. The intensity, frequency and duration of headaches as well as the number of analgesic pills consumed; were recorded in a diary at week 1 and week 4 of intervention. A 30 % decrease in headache index was taken as the minimum clinically important difference as per IHS guidelines. Results: The headache index decreased from 92.53±50.98 to 37.73±27.13 in the nortriptyline group and from 81.60±33.97 to 45.32±24.75 in the massage group (p=0.04, f:4.31). Headache intensity by the Visual Analogue Scale decreased from 5.37±1.66 to 3.37±1.44 in the nortriptyline group and from 5.00±1.98 to 3.81±1.31 in the massage group (p=0.03, f:4.5). Headache duration reduced from 16.88±11.43 to 10.12±11.43 hours in the nortriptyline group and from 15.83±5.83 to 11.87±5.50 hours in the massage group (p=0.04, f:4.07). Headache frequency decreased from 3.42+1.15 to 2.12±1.15 per week in the nortriptyline group and from 3.55+1.03 to 2.22±0.91 per week in the massage group (p=0.9, f:0.01). The number of analgesic pills used per week decreased from 2.85±1.49 to 1.22±1.27 in the nortriptyline and from 2.62±1.59 to 0.67±0.72 in the massage group (p=0.02, f:5.25). Conclusion: Trigger point massage is an effective and safe strategy for prophylactic treatment of CTTH, but is inferior to nortriptyline in terms of efficacy. [ABSTRACT FROM AUTHOR]

Background: Tension-type headache (TTH) is the most common form of primary headache.Objective: The aim of this study was to document and summarize the advances in the understanding of TTH in terms of pathogenesis and management.Material and Methods: We reviewed the available literature on the pathogenesis and management of TTH by searches of PubMed between 1969 and October 2020, and references from relevant articles. The search terms "tension-type headache", "episodic tension-type headache", chronic tension-type headache, "pathophysiology", and "treatment" were used.Results: TTH occurs in two forms: episodic TTH (ETTH) and chronic TTH (CTTH). Unlike chronic migraine, CTTH has been less thoroughly studied and is a more difficult headache to treat. Frequent ETTH and CTTH are associated with significant disability. The pathogenesis of TTH is multifactorial and varies between the subtypes. Peripheral mechanism (myofascial nociception) and environmental factors are possibly more important in ETTH, whereas genetic and central factors (sensitization and inadequate endogenous pain control) may play a significant role in the chronic variety. The treatment of TTH consists of pharmacologic and non-pharmacologic approaches. Simple analgesics like NSAIDs are the mainstays for acute management of ETTH. CTTH requires a multimodal approach. Preventive drugs like amitriptyline or mirtazapine and non-pharmacologic measures like relaxation and stress management techniques and physical therapies are often combined. Despite these measures, the outcome remains unsatisfactory in many patients.Conclusion: There is clearly an urgent need to understand the pathophysiology and improve the management of TTH patients, especially the chronic form. [ABSTRACT FROM AUTHOR]

SUMMARY INTRODUCTION: Chronic daily headache is a high impact entity in the general population. Although chronic migraine and tension-type headache are the most frequent conditions, it is necessary to consider hemicrania continua and new daily persistent headache as part of the differential diagnoses to perform a correct therapeutic approach. OBJECTIVE: To make recommendations for the treatment of chronic daily headache of primary origin METHODOLOGY: The Colombian Association of Neurology, by consensus and Grade methodology (Grading of recommendations, assessment, development and evaluation), presents the recommendations for the preventive treatment of each of the entities of the daily chronic headache of primary origin group. RESULTS: For the treatment of chronic migraine, the Colombian Association of Neurology recommends onabotulinum toxin A, erenumab, topiramate, flunarizine, amitriptyline, and naratriptan. In chronic tension-type headache the recommended therapeutic options are amitriptyline, imipramine, venlafaxine and mirtazapine. Topiramate, melatonin, and celecoxib for the treatment of hemicrania continua. Options for new daily persistent headache include gabapentin and doxycycline. The recommendations for inpatient treatment of patients with chronic daily headache and the justifications for performing neural blockades as a therapeutic complement are also presented. CONCLUSION: The therapeutic recommendations for the treatment of chronic daily headache based on consensus methodology and Grade System are presented.

Aim. To estimate the effect of reflexotherapy and standard pharmacological therapy on quality of life in patients with chronic tension-type headache (CTTH).Materials and methods. 95 patients (16 men and 79 women) with CTTH have been taken as the object of research. All patients were divided into two clinical groups. Patients of group 1 received amitriptyline 35-70 mg/day and tolperisone 450 mg/day. Patients of group 2 were assigned to 2-4 courses of injecting reflexotherapy according to the suggested methodology. The intensity of headache was assessed on the basis of scores on the Visual Analogous Scale (VAS). The quality of life was evaluated in all the patients with the aid of the SF-36 survey.Results. In both clinical groups there was decrease in quality of life in all scales except physical function (PF). All patients positively evaluated the results of the treatment. The intensity of pain reduced to 1,7±0,78 points (p0,05).Conclusion. CTTH significantly affect physical and mental components of patients’ health. The results obtained from the study showed the potential use of injecting reflexotherapy as treatment for CTTH.

Objective: The aim of this study was to describe a group of patients with chronic headache disorders (CH) and medication overuse headache (MOH) treated with intravenous chlorpromazine (IVC). We hypothesized that IVC is an effective and safe addition to well‐known treatment strategies for CH and MOH management. Introduction: Up to 4% of the general population could experience CH. Most cases occur in women, in association with MOH. To date, evidence to support different treatment strategies is lacking. Although IVC is frequently used in the emergency room (ER), documentation on its use as supportive treatment for CH and for withdrawal management of MOH is poor. Methods: A retrospective cohort of patients hospitalized to receive treatment for CH in a specialized neurological center in Argentina was analyzed. Results: A total of 35 CH patients were included. Of the 35 patients, 33 (94%) patients also presented MOH. Patients reported only minor side effects to IVC administration (mainly drowsiness and symptomatic hypotension). Three months after inpatient treatment, the number of ER visits made by these patients decreased from an average of 2.8 in the 3 months prior to hospitalization to 0.7 after it (72%, P =.009). Headache frequency decreased in 20/34 (59%) patients during the same time period. Pain levels had dropped from a mean of 8 points at admission (in the scale of 1‐10) to 2 points at discharge. In the first 3 months of follow‐up, the average number of days per month in which patients experienced headache decreased from 28.9 to 15.4 days (53.3%, P <.0001). Conclusion: In this particular group of inpatients, there were no significant safety issues with IVC administration and the study might suggest that the efficacy of IVC as an add‐on treatment for CH and MOH. [ABSTRACT FROM AUTHOR]

Background: Tension-type headache is the most common headache to be seen in clinical practice. Depression is highly prevalent in chronic tension-type headache (CTTH) patients attending the clinical settings. Cognitive impairment and neuroendocrine dysregulation had been reported in patients with depression and patients with CTTH. Objective: To assess the cognitive performance and investigate its possible relations to neuroendocrine levels in patients with CTTH. Subjects and methods: Patients with CTTH, depression, and control subjects were recruited. CTTH was diagnosed according to the International Classification of Headache Disorders. Cognitive performance, depression severity, and pain intensity were assessed by the Montreal Cognitive Assessment Arabic version, Beck's Depression Inventory, and McGill Pain Questionnaire respectively. Blood samples were collected in the morning within 60 min after waking up from 8:00 to 9:00 a.m. to measure serum levels of basal plasma CRH, ACTH, Cortisol, TSH, FT3, and FT4. Results: Both patients with CTTH and depression had impaired cognitive performance. Patients with CTTH and patients with depression had altered the hypothalamus-pituitary-adrenal axis, and pituitary-thyroid axis. The hormonal levels significantly correlated with cognitive function in patient groups, especially patients with CTTH. Conclusion: Patients with CTTH had cognitive dysfunction which could be related to neuroendocrine hormonal dysregulation. [ABSTRACT FROM AUTHOR]

Clinical electroneurophysiological mapping was performed in 30 patients with chronic migraine, in 41 patients with migraine without aura and in 40 patients with chronic headache of tension. In addition to the clinical examination psychological testing and polysynaptic blink reflex were used. It was established that an important neurophysiological phenomenon in chronic migraine is the increase in polysynaptic reflex excitability. It characterizes the failure of central inhibition and inefficiency of antinociceptive control in this disease.

Abstract Background The effectiveness of acupuncture for patients with chronic tension-type headache (CTTH) is controversial. In this article, we report the protocol for a randomized controlled trial aiming to evaluate the long-term effect of acupuncture for CTTH, in comparison with superficial acupuncture. Design A two-armed, parallel-design, patient-assessor blind, randomized controlled trial is underway in China. A total of 218 participants with CTTH will be randomly assigned to the treatment group or the control group in a 1:1 ratio. Participants in the treatment group and control group will receive acupuncture or superficial acupuncture treatments in a fixed prescription of acupoints respectively, for a total of 20 sessions over 8 weeks. The posttreatment follow-up period will be 24 weeks. The primary outcome will be the proportion of responders assessed at week 16 after randomization. The secondary outcomes will include the number of headache days, the mean intensity of headache, the reduction of medication intake, results from the 36-item short form health survey, the Hamilton Depression Scale and the Hamilton Anxiety Scale, the number of participants with adverse events, the expectation value of acupuncture treatment, and the intensity of deqi sensation. The first five secondary outcomes will be assessed or calculated at baseline, and at 4, 8, 12, 16, 20, 24, 28, and 32 weeks after randomization. Moreover, the expectation value will be collected at baseline and at week 8 after randomization, the intensity of deqi sensation will be assessed at 5 minutes after each treatment and adverse events will be summarized at the end of the follow-up period. Discussion Results from this trial will provide evidence for the long-term effect of acupuncture for CTTH with a long follow-up period. Trial registration ClinicalTrial.gov NCT03133884 . Registered on 25 April 2017.

Background: This study aims to evaluate the feasibility and efficacy of a complex health intervention, based on the combination of conventional Western medicine and traditional Chinese medicine (TCM), in an outpatient department of a university hospital for patients with frequent episodic or chronic tension-type headaches.Methods/design: This is a prospective randomized controlled pilot study with four balanced treatment arms (usual care, acupuncture, training, and training plus acupuncture). Each arm will have 24 patients. After the initial screening examination and randomization, a 6-week treatment period follows, with treatment frequencies decreasing at 2-week intervals. After completion of the intervention, two follow-up evaluations will be performed 3 and 6 months after the start of treatment. At predefined times, the various outcomes (pain intensity, health-related quality of life, pain duration, autonomic regulation, and heart rate variability) as well as the participants' acceptance of the complex treatment will be evaluated with valid assessment instruments (Migraine Disability Assessment, PHQ-D, GAD-7, and SF-12) and a headache diary. The acupuncture treatment will be based on the rules of TCM, comprising a standardized combination of acupuncture points and additional points selected according to individual pain localization. The training therapy comprises a combination of strength training, endurance training, and training to improve flexibility and coordination. Besides descriptive analyses of the samples, their comparability will be assessed using an analysis of variance (ANOVA) or chi-squared tests. Analyses will be performed on an intention-to-treat basis. Potential interaction effects will be calculated using a repeated-measures ANOVA to test the primary and secondary hypotheses. In supplementary analyses, the proportion of treatment responders (those with a 50% reduction in the frequency of pain episodes) will be determined for each treatment arm.Discussion: This trial may provide evidence for the additive effects of acupuncture and medical training therapy as a combination treatment and may scientifically support the implementation of this complex health intervention.Trial Registration: Registered on 11 Feburary 2019. German Clinical Trials Register, DRKS00016723. [ABSTRACT FROM AUTHOR]

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Background: Chronic headache (headache ≥15 days/month) is a leading cause of disability. Illness perception, beliefs and cognitive models are likely central for patient understanding of their chronic pain condition and are associated with treatment outcome. However, these factors are insufficiently described in chronic headache.Objective: To describe illness perception, and to explore the effect of background variables and headache characteristics on illness perceptions in primary and secondary chronic headaches in the general population.Methods: 30,000 persons aged 3044 from the general population were screened for chronic headache by a mailed questionnaire. Those with self-reported chronic headache were interviewed by headache specialists. The questionnaire response rate was 71%, and the interview participation rate was 74%. The International Classification of Headache Disorders III was applied. Illness perception was assessed by the Revised Illness Perception Questionnaire (IPQ-R). The statistical approach was exploratory.Results: 405 of the 516 eligible participants (78%) completed the IPQ-R. Confirmatory factor analysis showed good internal validity in chronic headache. People believed their chronic headache to be long-lasting, with negative life consequences including emotional distress. Severe headache-related disability was associated with more perception of chronicity, more perceived consequences, emotional load and illness identity and less illness coherence. People with secondary chronic headache scored significantly higher on chronicity and life consequences, and had less personal control than those with primary chronic headache.Conclusion: Chronic primary and secondary headache is associated with a high symptom burden and chronicity with large perceived negative consequences for daily living, suggesting multidisciplinary management may be necessary. [ABSTRACT FROM AUTHOR]

Background: Daily chronic headache (CCD) represents a syndromic spectrum of diagnostic and therapeutic complexity affecting 3 to 5% of the general population. Objective: To identify clinical, psychoaffective and neuropsychological predictors of good or poor response to the prophylactic pharmacological treatment of CCD. Methods: Patients with CCD in previous prophylactic pharmacological treatment with age between 20 and 60 years were included. Several psycho-affective tests evaluated the level of anxiety, perception of illness, stress and depression; while neuropsychological domains evaluated attention, work memory, fluency and verbal memory. Good response to treatment was defined as a reduction of ≥ 50% in pain frequency. Results: Forty patients with CCD (24 with chronic migraine and 16 with chronic tension-type headache) were included; 36 were women and 4 men with an average age of 40 years. Twenty patients were good responders (50%). A less frequency of headache (15 to 25 days per month) and the perception of treatment efficacy were associated with a good response (p = 0.053 and p = 0.008 respectively). There was significant tendency or association for better performance in work memory tests - inverse digits (p = 0.076), scalar digits score (p = 0.072), semantic verbal fluency (p = 0.001) and the fifth item of the Perri test for verbal memory and learning (p = 0.021) among responders. Conclusions: In this preliminary study, we identified a better overall and particular performance in some cognitive domains among patients with CCD and favorable response to established prophylactic treatment. [ABSTRACT FROM AUTHOR]

Tension-type headache ( TTH) is the most prevalent primary headache. Chronic TTH ( CTTH), the most serious form of TTH, is refractory, with a high socio-economic burden. Research studies have shown patients with migraine often had cognitive impairment, but few studies have focused on the cognition in patients with CTTH. In this study, we assumed that patients with CTTH also have cognitive impairments, which are modulated by the neuroendocrine state. Participants were recruited, including patients with CTTH and healthy controls. Cognitive ability was evaluated using the Montreal Cognitive Assessment and the Nine Box Maze Test. The administration of neuroendocrine hormones has been established to be associated with cognitive performance, and we detected the hormonal changes in the hypothalamus-pituitary-adrenal axis, the hypothalamus-pituitary-thyroid axis, and gonadotropin-releasing hormone. These results showed that compared to the controls, significant cognitive impairment and neuroendocrine dysfunction were present in the patients with CTTH. We also assessed the correlations between the neuroendocrine hormones and Pittsburgh Sleep Quality Index score, 17-term Hamilton's Depression Scale score, pain intensity, and duration of pain to determine whether the neuroendocrine hormones had any associations with these symptoms of CTTH. These results showed that changes in neuroendocrine hormones were involved in these symptoms of CTTH. Intervention with the neuroendocrine state may be a strategy for CTTH treatment. [ABSTRACT FROM AUTHOR]

Background: Chronic daily headache (CDH) patients respond better with a combination of anti-migraine and anti-stress medications, irrespective of clinical diagnosis of chronic migraine (CM) or chronic tension-type headache (CTTH). Hypothesis: "CDH: Mix headache" type is a valid clinical entity. Materials and Methods: A total of 70 participants fulfilling the diagnosis of "primary CDH," aged between 15 and 55 years were taken up for the present study. All these patients were subdivided into either CM or CTTH, based on the predominance of symptom profiles in these patients, in confirmation with the International Headache Society guidelines (International Classification of Headache Disorders-2, 2004). Schedules for clinical assessment in neuropsychiatry (SCAN) were applied to these patients to collect information about any mental or behavioral symptoms present at the time of the study. Psychiatric comorbidity was confirmed according to the International Classification of Diseases (ICD)-10. Results: Forty-eight (68.6%) patients could be differentiated into CM and rest 22 (31.4%) patients were given a diagnosis of CTTH. SCAN and ICD-10 diagnosis revealed the presence of comorbid anxiety and depressive illness in 47 (67.2%) patients. Thirty-four of them belonged to CM (MH) group and the rest 13 had CTTH. Discussion: We propose that these 47 (67.2%) patients of CDH form our special category of "CDH - mix headache" subtype. Thus, 14 (20%) patients constitute "CDH - migraine" subtype and rest 9 (12.8%) patients have a diagnosis of "CDH - tension headache" subtype. Conclusion: Findings of the present study validate the concept of "mix headache" and explains the clinical observation that chronic daily headache (CDH) patients responds better with a combination of anti-migraine and anti-stress medications. [ABSTRACT FROM AUTHOR]

Background: Headache, musculoskeletal symptoms, and vitamin D deficiency are common in the general population. However, the interrelations between these three have not been delineated in the literature. Materials and Methods: We retrospectively studied a consecutive series of patients who were diagnosed as having chronic tension-type headache (CTTH) and were subjected to the estimation of serum vitamin D levels. The subjects were divided into two groups according to serum 25(OH) D levels as normal (>20 ng/ml) or vitamin D deficient (