Search

Objectives: We used Cluster Analysis of Migraine-associated Symptoms (CAMS) to critically evaluate current International Classification of Headache Disorders-Third Edition (ICHD-3) migraine-associated symptoms criteria., Background: Diagnostic criteria play a central role in guiding clinical trial inclusion, and therefore available treatments. Migraine and tension-type headaches (TTH) are differentiated in ICHD-3 by many headache characteristics, including associated symptoms. A diagnosis of probable migraine indicates some but not all features of migraine are met. Photophobia and phonophobia, or nausea and/or vomiting, are required to meet a diagnosis of migraine; however, CAMS-a model that describes associated symptoms across youth with headache-indicates that a broader range of symptoms contain information about migraine burden., Methods: In this multisite retrospective cross-sectional study, we evaluated ICHD-3 migraine criteria. Youth aged 6-17 years with migraine (including probable migraine) or TTH were included in the analysis. We used CAMS to evaluate the migraine-associated symptom criterion. With CAMS as a guide, we evaluated how changes to the migraine-associated symptom criterion altered who met the diagnosis of migraine., Results: Of the 9017 participants included in this study, 66.7% were female and had a median (interquartile range) age of 13 (10-15) years. Most participants had migraine or probable migraine (99.0%), and the remainder had TTH (1.0%). A sizable percentage (10.1%) of youth under the umbrella diagnosis of migraine were diagnosed with probable migraine because they did not meet migraine-associated symptom criterion D; however, many in this group reported several non-ICHD migraine-associated symptoms. We explored alterations to criterion D based on CAMS. Allowing for photophobia or phonophobia re-categorized 55.6% of youth as having migraine, though some only had one symptom. Including lightheadedness or lightheadedness and spinning re-categorized 19.7% and 25.8% of youth with migraine, respectively, but all of those who were re-categorized had at least two migraine-associated symptoms., Conclusion: The ICHD-3 captures the most prevalent migraine-associated symptoms; however, many youths with probable migraine who do not meet full criteria due to insufficient associated symptoms nonetheless experience multiple non-ICHD migraine-associated symptoms. Changes to criterion D should be considered for the ICHD-4., (© 2024 The Author(s). Headache: The Journal of Head and Face Pain published by Wiley Periodicals LLC on behalf of American Headache Society.)

Background: There are reports from single-center studies on patients visiting headache clinics; however, few multicenter studies have been conducted in Japan. This study aims to address this gap by conducting a multicenter analysis of the clinical characteristics, headache types, severity, and psychiatric comorbidities of patients attending headache clinics., Methods: We prospectively evaluated the clinical characteristics of 2378 patients with headache disorders visiting three headache clinics. Baseline demographics, such as the visual analog scale (VAS), and psychiatric assessments, such as the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), were evaluated. Headache types were classified as migraine, tension-type headache (TTH), trigeminal autonomic cephalalgias (TACs), other primary headache disorders (OPHDs), and secondary headache. Parameters were compared between headache types using the Kruskal-Wallis test or analysis of covariance, as appropriate., Results: The most common headache type was migraine (78.8 %), followed by TTH (12.2 %), secondary headache (5.5 %), OPHDs (2.1 %), and TACs (1.6 %). Patients with migraine were significantly younger at first consultation (median age 32.0) than those with other headache types (TTH; 47.0, TACs; 39.0, OPHDs; 49.5, and secondary headache; 47.0). Patients with TACs exhibited the highest severity and psychiatric symptoms, with VAS (median 90.0), GAD-7 (7.0), and PHQ-9 (7.5) scores significantly higher than those of other headache type (migraine; 70.0, 5.0, 5.0, TTH; 50.0, 4.0, 4.0, OPHDs; 65.0, 4.0, 3.5, and secondary headache; 60.0, 3.0, 3.5: p<0.001, p=0.019, p<0.001)., Conclusion: Most patients visiting headache clinics had migraine; patients with TACs showed significantly higher headache severity and psychiatric symptoms than those with other headache types., Competing Interests: Declaration of Competing Interest The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: NI reports being an advisor for Sawai and received speaker fees from Daiichi Sankyo, Eli Lilly, Otsuka, and Amgen; however, these companies had no relation to the study. TT is a consultant/advisor and/or served on an advisory board for Eli Lilly, Otsuka, Amgen, Pfizer, and Teijin. TT received speaker honoraria from Eli Lilly, Daiichi Sankyo, Otsuka, Amgen, Kowa, Kyowa Kirin, Eisai, UCB Japan, Takeda, and Santen Pharmaceuticals and grant/funding from Eli Lilly, Pfizer and Tsumura unrelated to the submitted work. NW, none. YM reports personal consultancy fees from Amgen Astellas BioPharma K.K., Daiichi Sankyo Company Limited, Eli Lilly Japan K.K., and Otsuka Pharmaceutical Co., Ltd. during the conduct of the study; however, no company had any relation to the study., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: This study aimed to evaluate the choroidal vascular characteristics of patients followed up with different headache diagnoses., Design: Prospective comparative study., Methods: This study included 21 patients with migraine with visual aura (MwA), 20 with migraine without aura, 29 patients experiencing episodic tension-type headache, and 30 healthy participants. The participants was performed refraction values, axial length, and intraocular pressure were examined. Choroidal thickness was determined in all participants with HD-line optical coherence tomography (OCT) in the subfoveal, nasal, and temporal quadrants 500 µm from the fovea. Using special image processing software, luminal area (LA), stromal area, total choroidal area, and choroidal vascular index (CVI) values were calculated in both macular and peripapillary regions. OCT was also used to perform peripapillary retinal nerve fiber layer (pRNFL) thickness and optic disc head measurements., Results: Spherical refraction, axial length, and intraocular pressure values did not significantly differ among the four groups with similar gender and age distributions ( P > 0.05). The LA values in both macular and peripapillary regions were found to be statistically significantly lower in the MwA group ( P = 0.007 and P = 0.005, respectively). There was no statistically significant difference among the groups in terms of the remaining choroidal area parameters or CVI values ( P > 0.05). The groups also did not show any significant difference in the pRNFL or optic disc head measurements performed in different quadrants ( P > 0.05)., Conclusion: While LA, one of the choroidal vascular parameters, was found to be lower in the MwA group in both the macular and peripapillary regions, there were no statistically significant differences between the groups in terms of the peripapillary or macular CVI values., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Background: Headache disorders are globally prevalent and insufficient treatment contribute to low quality of life, increased disability, and socioeconomic costs. However, headache can to a large extent be treated appropriately by general practitioners., Objective: To explore general practitioners' (GPs') management of patients with headache lasting ≥6 months., Methods: In this retrospective descriptive cross-sectional study based on medical audit, all GPs practicing in Vejle municipality (population 116,992), Denmark, were invited to review their latest 20 patients with headache. Outcome measures were headache diagnostics, treatment, and referrals. Factors associated with referral to neurological treatment were examined by logistic regression., Results: Of 26 invited practices, 19 participated reporting on 367 patients with lasting headache (71.4% women; mean-age 48.5 years). One hundred and sixty-one patients had migraine (44%; IQR: 28-60%), 140 (38%; IQR: 25-44%) had tension-type headache; 243 (66%; IQR: 50-79%) used simple analgesics, 147 (40%; IQR: 29-59%) triptans, 37 (10%; IQR: 0-14%) opioids, 93 (25%; IQR: 20-35%) were prescribed preventive medication; 176 (48%; IQR: 48-59%) were referred to neurologist, and 92 (25%; IQR: 10-37%) were referred to CT or MRI scan. Associated factors for referral were >1 headache diagnosis (aOR 1.75 [95% CI: 1.05-2.95]; P = 0.03), post-traumatic headache (aOR 2.53 [95% CI: 1.25-5.38]; P = 0.01), unspecific headache (aOR 2.04 [95% CI: 1.08-3.93]; P = 0.03), and using preventive treatment (aOR 2.75 [95% CI: 1.68-4.57]; P < 0.001)., Conclusion: This study provides insights to how GPs manage patients with long-lasting headache. Focus should be on reducing opioids, increasing preventive treatment, and keeping more patients in primary care., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Pediatric headache is an increasing medical problem that has adverse effects on children's quality of life, academic performance, and social functioning. Children with primary headaches exhibit enhanced sensory sensitivity compared to their healthy peers. However, comprehensive investigations including multimodal sensory sensitivity assessment are lacking. This study aimed to compare sensory sensitivity of children with primary headaches with their healthy peers across multiple sensory domains., Methods: The study included 172 participants aged 6 to 17 years (M = 13.09, SD = 3.02 years; 120 girls). Of these 80 participants were patients with migraine, 23 were patients with tension-type headache, and 69 were healthy controls. The following sensory measures were obtained: Mechanical Detection Threshold (MDT), Mechanical Pain Threshold (MPT), Mechanical Pain Sensitivity (MPS), detection and pain threshold for Transcutaneous Electrical Nerve Stimulation (TENS), olfactory and intranasal trigeminal detection threshold, and odor identification ability. Sensory sensitivity was compared between groups with a series of Kruskal-Wallis tests. Binomial regression models were used to compare the relative utility of sensory sensitivity measures in classifying participants into patients and healthy controls, as well as into patients with migraine and tension-type headache., Results: Patients with migraine had lower MPT measured at the forearm than patients with tension-type headaches and healthy controls. MPS was higher in patients with migraine than in healthy controls. All patients with headaches had lower detection threshold of TENS and higher olfactory sensitivity. Healthy controls showed increased intranasal trigeminal sensitivity. Scores in MPS, TENS, and olfactory and trigeminal thresholds were significantly predicting presence of primary headaches. Additionally, scores in MPT, olfactory and trigeminal threshold were positive predictors of type of headache., Conclusions: Children with primary headaches exhibit different sensory profiles than healthy controls. The obtained results suggest presence of increased overall, multimodal sensitivity in children with primary headaches, what may negatively impact daily functioning and contribute to further pain chronification., Trial Registration: The study was registered in the German Registry of Clinical Trials (DRKS) DRKS00021062., (© 2024. The Author(s).)

Purpose of Review: Tension-type headache (TTH) continues to be the most prevalent type of headache across all age groups worldwide, and the global burden of migraine and TTH together account for 7% of all-cause years lived with disability (YLDs). TTH has been shown to have a prevalence of up to 80% in several studies and presents a wide range and high variability in clinical settings. The aim of this review is to identify gaps in diagnostics, nosology, and variability in the treatment of children and adolescents who present with headaches without an identifiable etiology., Recent Findings: Migraine and TTH have been debated to have more similarities than distinctions, increasing chances of misdiagnosis and leading to significant cases diagnosed as probable TTH or probable migraine. The lack of specificity and sensitivity for TTH classification often leads to the diagnosis being made by negating associated migraine symptoms. Although pathology is not well understood, some studies have suggested a neurological basis for TTH, in need of further validation. Some research indicates that nitric oxide signaling plays an integral part in the pain mechanisms related to TTH. Analgesics and non-steroidal anti-inflammatories are usually the first lines of treatment for children with recurring headaches, and additional treatment options include medication and behavioral therapies. With high prevalence and socioeconomic burden among children and adolescents, it's essential to further study Tension-type headaches and secondary headaches without known cause and potential interventions. Treatment studies involving randomized controlled trials are also needed to test the efficacy of various treatments further., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: To examine the effects of acupuncture and therapeutic exercise alone and in combination on temporomandibular joint symptoms in tension-type headache and to evaluate the potential interaction of existing temporomandibular dysfunction on the success of headache treatment., Design: Pre-planned secondary analysis of a randomized controlled, non-blinded trial., Setting: Outpatient clinic of a German university hospital., Subjects: Ninety-six Participants with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups., Interventions: Six weeks of acupuncture or therapeutic exercise either as monotherapies or in combination, or usual care. Follow-up at 3 and 6 months., Main Measures: Subjective temporomandibular dysfunction symptoms were measured using the Functional Questionnaire Masticatory Organ, and the influence of this sum score and objective initial dental examination on the efficacy of headache treatment interventions was analyzed., Results: Temporomandibular dysfunction score improved in all intervention groups at 3-month follow-up (usual care: 0.05 [SD 1.435]; acupuncture: -5 [SD 1.436]; therapeutic exercise: -4 [SD 1.798]; combination: -3 [SD 1.504]; P  = 0.03). After 6 months, only acupuncture (-6 [SD 1.736]) showed a significant improvement compared to the usual care group ( P  < 0.01). Subjective temporomandibular dysfunction symptoms had no overall influence on headache treatment., Conclusions: Only acupuncture had long-lasting positive effects on the symptoms of temporomandibular dysfunction. Significant dental findings seem to inhibit the efficacy of acupuncture for tension-type headache., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective This study examined the prevalence of migraine in nurses in Japan, which, to our knowledge, has not been documented in English. Methods From April to May 2021, we administered a questionnaire to 229 nurses working at Keio University Hospital to investigate the prevalence and characteristics of headache among nurses in Japan. Headaches were classified as migraine or tension-type headache (TTH) based on the International Classification of Headache Disorders 3rd edition (ICHD-3). Results In total, 80 patients (34.9%) had primary headaches, including 47 (20.5%) with migraine and probable migraine and 33 (14.4%) with TTH and probable TTH. We found a significant difference in the Numerical Rating Scale score, nausea and vomiting, photophobia, phonophobia, and aggravation by routine physical activity between migraine and TTH. The specificities for a migraine diagnosis were 100% and 93.9% for nausea/vomiting and photophobia, respectively. Only 8.8% of patients had their headaches diagnosed by a physician. Conclusion Migraines have a high prevalence (>20%) among nurses and are often under-diagnosed. In many cases, headache-associated symptoms are more important than laterality or other characteristics for the diagnosis. Many nurses are treated for headaches without a correct diagnosis. Further education regarding primary headaches may be necessary for health practitioners as well as society.

Objective: To investigate the relationship between mental health symptoms and the migraine-tension-type headache (TTH) spectrum in middle-aged adults from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil study)., Methods: In this cross-sectional analysis (baseline data: 2008-2010), it was evaluated the relationship between each mental health symptom assessed by the Clinical Interview Schedule-Revised (CIS-R) questionnaire and headache subtypes (migraine and TTH) according to international criteria. It was performed binary logistic regression models, with estimated odds ratios (OR) with their respective 95% confidence intervals (CI) adjusted for confounders including migraine attack frequency., Results: Among 13,916 participants, 70.1% reported any major primary headache subtype within the last year. The most common subtype was definite TTH (33.4%), followed by probable migraine (21.0%), definite migraine (8.5%), and probable TTH (7.2%). Our main findings indicated positive associations between anxiety-related symptoms and the migraine-tension type headache (TTH) spectrum with a clear trend toward definite migraine more than tension-type headache. The presence of somatic symptoms presented a high likelihood for the associations with headaches, mainly definite migraine (OR: 7.9, 95% CI: 6.4-9.8), probable migraine (OR: 4.5, 95% CI 3.7-5.4) and probable TTH (OR: 3.0, 95% CI: 2.3-3.8). Other symptoms associated with headache disorders included fatigue, panic, irritability, anxiety symptoms, concentration problems, forgetfulness, depressive symptoms, and worry. The effect of associations remained significant after controlling for headache attack frequency., Conclusion: This study provides evidence of consistent associations between mental health symptoms and primary headache disorders, with a higher burden of anxiety-based symptoms observed in people with migraine than those with TTH., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction and Objective: Menstrual migraine (MM) is widely recognized among the scientific community, with diagnostic criteria included in the appendix of the third edition of the International Headache Classification. However, this classification does not include other primary headaches that may occur during menstruation. Previous retrospective studies suggest the existence of menstrual tension-type headache. Our objective is to prospectively determine the existence of this type of headache and to determine its frequency relative to that of MM., Methods: This is a descriptive, cross-sectional (case series), prospective, observational study, conducted in a hospital neurology department, using a previously validated ad hoc questionnaire. Participants were recruited by consecutive sampling, applying inclusion and exclusion criteria among women accompanying neurology outpatients, and classified into five groups: pure menstrual tension-type headache, menstrual-related tension-type headache, pure menstrual migraine, menstrual-related migraine and unclassifiable., Results: Ninety-five women (median age of 38.50 years, IQR: 13) were included, with the following group distribution: 13 (13.6%) pure menstrual tension-type headache, 14 (14.7%) menstruation-related tension-type headache, 23 (24.2%) pure menstrual migraine, 44 (46.3%) menstrual-related migraine and 1 unclassifiable. Of these patients, 23% did not treat menstrual headache, but this figure rose to 30.8% in the case of pure menstrual tension-type headache., Conclusion: The results confirm the existence of pure menstrual tension-type headache among women who do not seek medical care for this condition. The frequency of this headache is lower than that of MM. This reduced incidence, together with its generally mild nature, may explain the lack of prior recognition., (© 2023. The Author(s) under exclusive licence to Belgian Neurological Society.)

Objective: To study the features of the primary forms of headache in patients with a confirmed diagnosis of multiple sclerosis (MS)., Material and Methods: A total of 110 patients with MS were examined in the outpatient appointment of a neurologist at the Department of Neurology and Neurosurgery of the «Smolensk State Medical University» in the period from April 1, 2023 to May 31, 2023. A group of 20 people with a diagnosis of primary headache (PH) was selected. At the same time, a control group of 20 people with a diagnosis of PH was selected on the basis of the Center for Industrial Medicine of the Federal State Medical Institution MSU No. 135, Desnogorsk. The analysis of complaints, anamnestic, laboratory data, neurological status and test results on specialized scales was carried out., Results: Migraine was the most frequent type of headache in MS patients (in a ratio of 5.6:1 compared to tension headache) and was observed in 17 (85%) MS patients. Tension headache was diagnosed only in 3 (15%) patients ( p =0.002). Headache was significantly more common in the remitting form of MS ( p =0.046). Age, total cholesterol level, EDSS level, type of MS disease-modifying therapy were not associated with the risk of developing headache. When comparing the population of patients with MS and PH with the control group on the anxiety and depression scale and the MoCA test, statistically significant differences were obtained ( p <0.05)., Conclusion: PH were diagnosed in 18.2% of patients with MS, with a much higher prevalence of migraines than tension headache. In addition, female gender and the type of MS are significantly associated with the risk of migraine. Migraine, as a comorbid condition, can aggravate cognitive impairment in patients with MS, characterized by a lower value of the MoCA scale, especially together with the progression of anxiety and depressive disorders. These findings indicate the need for a larger epidemiological study to accurately assess the prevalence of PH in patients with MS in the Smolensk region.

Purpose of Review: The aim of this narrative review is to analyze the evidence about a peripheral or central origin of a tension headache attack in order to provide a further clarification for an appropriate approach., Recent Findings: Tension headache is a complex and multifactorial pathology, in which both peripheral and central factors could play an important role in the initiation of an attack. Although the exact origin of a tension headache attack has not been conclusively established, correlations have been identified between certain structural parameters of the craniomandibular region and craniocervical muscle activity. Future research should focus on improving our understanding of the pathology with the ultimate goal of improving diagnosis. The pathogenesis of tension-type headache involves both central and peripheral mechanisms, being the perpetuation over time of the headache attacks what would favor the evolution of an episodic tension-type headache to a chronic tension-type headache. The unresolved question is what factors would be involved in the initial activation in a tension headache attack. The evidence that favors a peripheral origin of the tension headache attacks, that is, the initial events occur outside the brain barrier, which suggests the action of vascular and musculoskeletal factors at the beginning of a tension headache attack, factors that would favor the sensitization of the peripheral nervous system as a result of sustained sensory input., (© 2023. The Author(s).)

Introduction: Headache is a frequent symptom of infections. We aimed to characterize the clinical phenotype and duration of headache attributed to influenza infection., Methods: Prospective cohort study done in 53 primary care centers between January and April 2023. Patients were included if they had a confirmed influenza diagnosis, were older than 15 years and had a new-onset headache. Patients' demographics, prior medical history, headache phenotype and duration, associated symptoms and patients' outcomes were assessed. The International Classification of Headache Disorders criteria for headache attributed to a systemic viral infection, migraine and tension-type headache were assessed., Results: Of the 478 patients 75 fulfilled eligibility criteria. The mean age was 43, 56% were men, and 27% had a prior headache history. The headache phenotype was a bilateral headache (52%), with frontal topography (48%), pressing quality (61%), moderate intensity, rhinorrhea (79%), nasal congestion (76%), and photophobia (59%). All patients fulfilled headache attributed to acute systemic viral infection criteria, 43% fulfilled migraine criteria and 31% tension-type headache criteria. The median duration of the headache was four (Inter-quartile range: two-six) days., Conclusion: The clinical phenotype of headache attributed to influenza infection was similar to other infections, with more pronounced cranial autonomic symptoms. The headache was an early symptom and was self-limited within a few days. Trial Registration: The study protocol is registered in ClinicalTrial.gov (NCT05704335)., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DGA received honoraria for lectures/presentations from Abbvie/Allergan, Eli Lilly, Teva, Lundbeck, and Novartis. DGA Participated in clinical trials as the principal investigator for Pfizer, BioHaven and Lundbeck. DGA is junior editor of The Journal of Headache and Pain and Neurological Sciences. DGA received honoraria from the World Health Organization as subject matter expert.ÁLGP received honoraria for lectures/presentations from Abbvie/Allergan, Eli Lilly, Teva, Lundbeck, and Novartis. ALGP Participated in clinical trials as the principal investigator for Eli Lilly, Teva, Abbvie, Novartis, Amgen and Lundeck.All other authors report no conflicts of interest.

Background: Few reports have described multidisciplinary treatment, including extracorporeal shock wave therapy, for patients with refractory chronic tension-type headache. In this study, we conducted multidisciplinary treatment for a patient with chronic tension-type headache who suffered from chronic headache refractory to treatment., Case Presentation: The patient was a 45-year-old Japanese male suffering from 20 years of headache. As his headache had worsened recently, he visited a local clinic. With the diagnosis of suspected tension-type headache, its treatment was unsuccessful and he was referred to our hospital. The neurology department confirmed the tension-type headache and prescribed another medication, but he showed no improvement. Then, the patient was referred to the rehabilitation medicine department for consultation. At the initial visit, we identified multiple myofascial trigger points in his bilateral posterior neck and upper back regions. At the initial visit, he was prescribed 10 mL of 1% lidocaine injected into the muscles in these areas. In addition, he received 2000 extracorporeal shock wave therapy into bilateral trapezius muscles, and was instructed to take oral Kakkonto extract granules, benfotiamine, pyridoxine hydrochloride, and cyanocobalamin. Cervical muscle and shoulder girdle stretches and exercises were also recommended. At follow-up treatment visits, we used extracorporeal shock wave therapy to bilateral trapezius muscles, which led to immediate pain relief. After 11 weeks, he was not taking any medication and his headache was subjectively improved and his medical treatment ended., Conclusion: A patient with chronic tension-type headache refractory to regular treatment was successfully treated with a multimodal approach including extracorporeal shock wave therapy in addition to standard treatment. For patients with tension-type headache accompanied by myofascial trigger points, it may be recommended to promptly consider aggressive multimodal treatment that includes extracorporeal shock wave therapy., (© 2023. The Author(s).)

Objective: To examine the relative contribution of headache symptoms and psychological factors to headache-related disability., Background: Both headache symptoms and comorbid psychological factors (psychiatric symptoms and transdiagnostic constructs) negatively impact functioning among individuals with migraine and tension-type headache, but few studies have explored their relative contribution to headache-related disability. We hypothesized that psychiatric symptoms and transdiagnostic variables would afford incremental contribution to disability beyond headache symptoms, and we investigated the moderating role of headache diagnosis on these relationships., Methods: This cross-sectional study examined data from a southern U.S. university online sample of 1818 young adults (mean [SD] age 19.0 [5.1] years; 74.6% female) who met the International Classification of Headache Disorders, third edition criteria for primary headache disorders (46.6% episodic migraine, 11.6% chronic migraine, 38.3% episodic tension-type headache, 3.5% chronic tension-type headache) and completed measures assessing psychological factors and headache-related disability. Headache, psychiatric symptoms, and transdiagnostic factors were examined in relation to headache-related disability, after controlling for sex. Moderation analyses examined the conditional effect of diagnosis on disability., Results: As predicted, both psychiatric and transdiagnostic symptoms accounted for unique variance in headache-related disability beyond headache symptoms (R 2 changes of 2.7% and 2.3%, respectively). Significant three-way interactions revealed the relationship between psychiatric symptoms and disability (b = -3.16, p = 0.002), and between transdiagnostic variables and disability (b = -2.37, p = 0.034). Tests of simple slopes showed greater psychiatric symptoms and transdiagnostic variables were associated with higher levels of disability. However, the associations of these variables with disability were strongest among individuals with chronic tension-type headache (B = 3.93 for psychiatric symptoms and B = 4.62 for transdiagnostic symptoms, both p < 0.001)., Conclusion: Psychiatric and transdiagnostic factors contribute uniquely to headache-related functional impairment, which may be important for expanding targeted assessment and behavioral interventions., (© 2023 American Headache Society.)

Background: There have been no recent meta-analysis studies on specific psychological symptoms (depression and anxiety) according to the type of primary headache disorder in children and adolescents., Objectives: We performed a meta-analysis of various psychodiagnostic scales. Psychological symptoms of primary headache disorders have been reported in previous studies., Study Design: A systematic review and meta-analysis., Methods: We conducted systematic reviews using the PubMed, Embase, Cochrane Library, and Scopus databases up to October 19, 2022. Ten studies were selected by applying the inclusion criteria. The psychological symptoms (depression and anxiety) of children and adolescents with migraine and tension-type headache (TTH) were compared with those of healthy controls using scale scores. All statistical analyses of the pooled data were performed using RevMan 5.3 software., Results: Psychodiagnostic tools to assess depression scored higher in patients with migraine than in healthy controls; however, most anxiety-related scores were not significantly different between the migraine and control groups. In contrast, anxiety-related scores were higher in patients with TTH than in healthy controls, but the score to measure the degree of depressive symptoms was not significantly different from the control group in patients with TTH., Limitations: A limited number of studies for each scale were included. In addition, each scale has different sensitivities and specificities, which may have affected the results. In addition, we did not evaluate the differences in psychological symptoms according to the frequency and severity of headaches., Conclusions: Depression is more associated with migraine; whereas, anxiety is more associated with TTH than healthy controls. Therefore, the screening and assessment of psychological symptoms should be performed in children and adolescents with primary headache disorders.

Background: Headache disorders are widely prevalent and pose a considerable economic burden on individuals and society. Globally, misdiagnosis and inadequate treatment of primary headache disorders remain significant challenges, impeding the effective management of such conditions. Despite advancements in headache management over the last decade, a need for comprehensive evaluations of the status of primary headache disorders in China regarding diagnosis and preventative treatments persists., Methods: In the present study, we analyzed the established queries in the Survey of Fibromyalgia Comorbidity with Headache (SEARCH), focusing on previous diagnoses and preventative treatment regimens for primary headache disorders. This cross-sectional study encompassed adults diagnosed with primary headache disorders who sought treatment at 23 hospitals across China between September 2020 to May 2021., Results: The study comprised 2,868 participants who were systematically examined. Migraine and tension-type headaches (TTH) constituted a majority of the primary headache disorders, accounting for 74.1% (2,124/2,868) and 23.3% (668/2,868) of the participants, respectively. Medication overuse headache (MOH) affected 8.1% (231/2,868) of individuals with primary headache disorders. Over half of the individuals with primary headache disorders (56.6%, 1,624/2,868) remained undiagnosed. The previously correct diagnosis rates for migraine, TTH, TACs, and MOH were 27.3% (580/2,124), 8.1% (54/668), 23.2% (13/56), and 3.5% (8/231), respectively. The misdiagnosis of "Nervous headache" was found to be the most prevalent among individuals with migraine (9.9%, 211/2,124), TTH (10.0%, 67/668), trigeminal autonomic cephalalgias (TACs) (17.9%, 10/56), and other primary headache disorders (10.0%, 2/20) respectively. Only a minor proportion of individuals with migraine (16.5%, 77/468) and TTH (4.7%, 2/43) had received preventive medication before participating in the study., Conclusions: While there has been progress made in the rate of correct diagnosis of primary headache disorders in China compared to a decade ago, the prevalence of misdiagnosis and inadequate treatment of primary headaches remains a veritable issue. As such, focused efforts are essential to augment the diagnosis and preventive treatment measures related to primary headache disorders in the future., (© 2023. Springer-Verlag Italia S.r.l., part of Springer Nature.)

Introduction: Neck pain is a prevalent neurologic and musculoskeletal complaint in the general population and is often associated with primary headache disorders such as migraine and tension-type headache (TTH). A considerable proportion, ranging from 73% to 90%, of people with migraine or TTH also experience neck pain, and there is a positive correlation between headache frequency and neck pain. Furthermore, neck pain has been identified as a risk factor for migraine and TTH. Although the exact underlying mechanisms linking neck pain to migraine and TTH remain uncertain, pain sensitivity appears to play an important role. People with migraine or TTH exhibit lower pressure pain thresholds and higher total tenderness scores compared with healthy controls., Purpose: This position paper aims to provide an overview of the current evidence on the relationship between neck pain and comorbid migraine or TTH. It will encompass the clinical presentation, epidemiology, pathophysiology, and management of neck pain in the context of migraine and TTH., Implications: The relationship between neck pain and comorbid migraine or TTH is incompletely understood. In the absence of robust evidence, the management of neck pain in people with migraine or TTH relies mostly on expert opinion. A multidisciplinary approach is usually preferred, involving pharmacologic and non-pharmacologic strategies. Further research is necessary to fully dissect the linkage between neck pain and comorbid migraine or TTH. This includes the development of validated assessment tools, evaluation of treatment effectiveness, and exploration of genetic, imaging, and biochemical markers that might aid in diagnosis and treatment., (Copyright © 2023. Published by Elsevier Ltd.)

Tension-type headache (TTH) and migraine are two common primary headaches distinguished by clinical characteristics according to the 3 rd edition of the International Classification of Headache Disorders. Migraine is identified by specific features such as being more prevalent in females, being aggravated by physical activity, certain genetic factors, having photophobia, phonophobia, nausea, vomiting, or aura, and responding to specific drugs. Nonetheless, TTH and migraine share some common characteristics, such as onset occurring in the 20 s, and being triggered by psychological factors like stress, moderate pain severity, and mild nausea in chronic TTH. Both conditions involve the trigeminovascular system in their pathophysiology. However, distinguishing between TTH and migraine in clinical practice, research, and epidemiological studies can be challenging, as there is a lack of specific diagnostic tests and biomarkers. Moreover, both conditions may coexist, further complicating the diagnostic process. This review aims to explore the similarities and differences in the pathophysiology, epidemiology, burden and disability, comorbidities, and responses to pharmacological and non-pharmacological treatments of TTH and migraine. The review also discusses future research directions to address the diagnostic challenges and improve the understanding and management of these conditions., (© 2023. The Author(s).)

Purposes: To compare the effectiveness of instrument-assisted soft tissue mobilization (IASTM) and pressure algometry with sham ultrasound (control group) on the clinical measures of headache, pressure pain threshold (PPT) of upper trapezius and suboccipital muscles and cervical alignment in patients with tension type headache (TTH)., Methods: Seventy-two patients with TTH of both genders were randomly allocated to 3 experimental groups: a) the IASTM group (n=24), b) pressure algometry group (n=24), and c) sham ultrasound control group (n=24). Headache frequency and disability, pressure pain threshold of upper trapezius and suboccipital muscles, cervical lordosis angle (CA) and anterior head translation (AHT) were measured four weeks before and after intervention. Moreover, headache frequency was followed up for two more weeks after intervention., Results: Statistically significant improvements (P <0.05; effect size ranges 1.1-1.9) were observed in all outcome measures following IASTM compared to the other two intervention methods. In the IASTM group, the headache frequency decreased from 15 to 2 days/month. Also, headache disability decreased from 19 to 10. Further, CA increased from 17.5° to 31.4° and AHT decreased from 24.1 to 15.5 mm. The pressure algometry group showed significantly lower headache frequency at the follow-up (P < 0.01) than the sham ultrasound control group. However, Similar findings in the other evaluated outcomes were found between the pressure algometry and sham ultrasound control groups (P ˃ 0.05)., Conclusion: The results of the present study indicate the effectiveness of IASTM in improving headache symptoms and cervical alignment in patients with TTH.

Headaches are one of the most frequent causes of consultations in general practice. Of more than 350 known headache tendencies, tension-type headache and migraine are particularly common in general practice. Medication overuse headache (MOH) is also common but rarely diagnosed. The medical consultation with a targeted anamnesis is the cornerstone of the diagnosis and correct classification. A detailed neurological examination completes the basic diagnosis. Additional laboratory and instrumental diagnostics follow in cases of atypical headache or clinical suspicion of secondary headache. This article focuses on the diagnosis and treatment of Tension-type Headache, migraine and Medication Overuse Headache., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Although headache disorders are common, the current diagnostic approach is unsatisfactory. Previously, we designed a guideline-based clinical decision support system (CDSS 1.0) for diagnosing headache disorders. However, the system requires doctors to enter electronic information, which may limit widespread use., Methods: In this study, we developed the updated CDSS 2.0, which handles clinical information acquisition via human-computer conversations conducted on personal mobile devices in an outpatient setting. We tested CDSS 2.0 at headache clinics in 16 hospitals in 14 provinces of China., Results: Of the 653 patients recruited, 18.68% (122/652) were suspected by specialists to have secondary headaches. According to "red-flag" responses, all these participants were warned of potential secondary risks by CDSS 2.0. For the remaining 531 patients, we compared the diagnostic accuracy of assessments made using only electronic data firstly. In Comparison A, the system correctly recognized 115/129 (89.15%) cases of migraine without aura (MO), 32/32 (100%) cases of migraine with aura (MA), 10/10 (100%) cases of chronic migraine (CM), 77/95 (81.05%) cases of probable migraine (PM), 11/11 (100%) cases of infrequent episodic tension-type headache (iETTH), 36/45 (80.00%) cases of frequent episodic tension-type headache (fETTH), 23/25 (92.00%) cases of chronic tension-type headache (CTTH), 53/60 (88.33%) cases of probable tension-type headache (PTTH), 8/9 (88.89%) cases of cluster headache (CH), 5/5 (100%) cases of new daily persistent headache (NDPH), and 28/29 (96.55%) cases of medication overuse headache (MOH). In Comparison B, after combining outpatient medical records, the correct recognition rates of MO (76.03%), MA (96.15%), CM (90%), PM (75.29%), iETTH (88.89%), fETTH (72.73%), CTTH (95.65%), PTTH (79.66%), CH (77.78%), NDPH (80%), and MOH (84.85%) were still satisfactory. A patient satisfaction survey indicated that the conversational questionnaire was very well accepted, with high levels of satisfaction reported by 852 patients., Conclusions: The CDSS 2.0 achieved high diagnostic accuracy for most primary and some secondary headaches. Human-computer conversation data were well integrated into the diagnostic process, and the system was well accepted by patients. The follow-up process and doctor-client interactions will be future areas of research for the development of CDSS for headaches., (© 2023. The Author(s).)

Aim: The aim of the study to determine the migraine prevalence and self-management of migraine among the neurologists and neurology residents registered to the Turkish Neurological Society., Methods: This cross-sectional study includes 851 participants. Based on the "The International Classification of Headache Disorders, 3rd edition" and previous literature, an anonymous questionnaire was prepared and used to collect data online via Google Forms. The link to the study was posted on the website of the Turkish Neurological Society., Results: Women (73.2%) and neurologists (77.4%) made up the majority of the participants. Of the participants, 37.9% met the diagnosis criteria for migraine. Being women and positive family history were associated with migraine compared to the tension-type headache (TTH) (both p values < 0.001). Comparing with the TTH sufferers, migraine significantly hindered work, social, and family life (all p values < 0.001). Participants with migraine had more magnetic resonance imaging (MRI) (47.4%) and electroencephalography (EEG) (4.3%) than those with TTH (both p values < 0.05). Participants with migraine received drug prophylaxis more frequently (20.1%) than those with TTH (2.3%) (p < 0.001), and these drugs were selective serotonin reuptake inhibitors (SSRIs) (7.1%), beta-blockers (5.9%), and serotonin-norepinephrine reuptake inhibitors (SNRIs) (5.3%) (all p values < 0.05). Participants with migraine received non-pharmacological prophylaxis for headache more frequently (25.7%) compared to those with TTH (p < 0.001)., Conclusions: Migraine is common among neurologists and neurology residents. Identifying migraine self-management is important for preventing the loss of work and negative economic and social consequences that migraine may cause in these groups of physicians., (© 2022. The Author(s) under exclusive licence to Belgian Neurological Society.)

Objective: Children with primary headache are particularly vulnerable to the negative impacts of the pandemic due to factors like increased social isolation, disruption of sleep and impairment of healthy diet. We aimed to investigate the clinical changes and triggering factors for childhood primary headaches to demonstrate the impact of the pandemic lockdown., Method: Children aged between 60 months and 18 years with headache complaint attending the general outpatient clinic between December 2019 and December 2020 were included in the study. Patients were classified according to ICHD-3 regarding clinical and laboratory data. Primary headaches diagnosed before (December 2019-March 2020) and during the pandemic lockdown (April 2020-December 2020) were divided into two groups as migraine and tension-type headache (TTH). Clinical picture and triggering factors were compared between groups to illustrate the effect of the lockdown., Results: The study included 612 subjects, with 463 patients (76%) classified in the primary headache group and 149 (24%) in the secondary headache group. Among the first group, 267 patients (58%) had migraine and 196 patients (42%) had TTH. Comparisons between before and during the pandemic lockdown showed significant increased frequency of TTH, but no difference in the frequency and duration of migraine. Both screen exposure and sleep pattern changes were found to be significantly increased in the TTH group during the pandemic lockdown., Discussion: We found a significant increase in the attack frequency for TTH patients during the pandemic lockdown. Reduction in screen time is an important strategy in preventing primary headache attacks in children., (© 2022. The Author(s) under exclusive licence to Belgian Neurological Society.)

Objectives: To compare the effects of acupuncture and medical training therapy in combination or individually with usual care on quality of life, depression, and anxiety in patients with tension-type headache., Methods: In this single-center, prospective, randomized, controlled, unblinded trial, 96 adults (38.7(+/-13.3) years of age; 75 females/20 males/one dropout) with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups (n = 24). The treatment groups received six weeks of either acupuncture or medical training therapy as monotherapies or in combination (12 interventions each), or usual care. We assessed depressiveness (PHQ-9), anxiety (GAD-7), and health-related quality of life (SF-12) as secondary outcome parameters at baseline, six weeks, three months, and six months after initiation of treatment. Linear mixed models were calculated., Results: Both, acupuncture (baseline to six-weeks change scores: mean: -2(standard deviation: 2.5 points), three months: -2.4(2.4), six-months -2.7(3.6)) and the combination of acupuncture and medical training therapy (-2.7(4.9), -2.2(4.0), -2.2(4.2)) (each within-group p < .05) significantly reduced depressiveness-scores (PHQ-9) to a greater extent than medical training therapy (-0.3(2.0), -0.5(1.6), -0.9(2.6)) or usual care alone (-0.8(2.9), 0.1(2.8), 0.2(3.6)). We found similar results with anxiety scores and the physical sum scores of the SF-12. No severe adverse events occurred., Conclusions: Acupuncture and the combination of acupuncture and medical training therapy elicit positive effects on depression, anxiety, quality of life, and symptom intensity in patients with episodic and chronic tension-type headache. Acupuncture appears to play a central role in mediating the therapeutic effects, underscoring the clinical relevance of this treatment. An additive benefit of the combination of both therapies does not appear to be relevant. Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.

Background: Headaches are among the most common complaints observed in neurology and medicine, notably migraines and tension-type headaches (TTH)., Objective: The purpose of this study was to compare hematologic parameters comprised hemoglobin, hematocrit, platelets, leukocytes, neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) between migraineurs and tension-type headache patients., Methods: This cross-sectional study included 23 migraineurs and 23 TTH-diagnosed patients, in accordance with the International Classification of Headache Disorders-3 beta version (ICHD-3-beta). The patients underwent hematological laboratory testing, which included assessments of their serum levels of hemoglobin, hematocrit, platelets, leucocytes as well as neutrophils, lymphocytes and monocytes., Results: There were significant differences in the mean platelets serum levels between migraineurs and TTH patients, with migraineurs having 355.3 x 103/μl (SD±47.4 x 103/μl) and TTH patients having 282.0 x 103 /μl (SD± 44.2 x 103) /μl, respectively (p = 0.001). However, there were no differences in the mean level of hemoglobin, hematocrit and leukocytes between the two groups. There was also a significant difference in PLR between migraineurs and TTH patients, with a ratio of 138.1 (SD±36.0) in migraineurs and 110.2 (SD±21.9) in TTH patients (p =0.003), but no differences in NLR or LMR., Conclusion: The mean serum levels of platelets and platelets-to-lymphocyte ratio of migraineurs were significantly higher than TTH patients. However, there were no differences in the mean levels of hemoglobin, hematocrit, leukocytes, NLR and LMR between the two groups., Competing Interests: There are no conflicts of interest., (© 2023 Khairul Putra Surbakti, Chairil Amin Batubara, Eka Mahendrayana.)

Objective: To study the prevalence of trigger factors and associated disorders in tension-type headache (TTH). Trigger factors have been widely studied in the context of migraine, but very few studies have investigated trigger factors in the context of TTH., Materials and Methods: A total of 400 patients above the age of 15 years fulfilling the third edition of the International Classification of Headache Disorders (ICHD 3) criteria of frequent episodic tension-type headache (FETTH) and chronic tension-type headache (CTTH) were enrolled and evaluated using a questionnaire. Details regarding demographics, headache characteristics, triggers, and associated symptoms were obtained. Associated psychiatric disorders were also recorded. Data were analyzed using Microsoft Excel and statistical analysis was done using SPSS 22 trial version. Chi-square test and Fischer's exact test were used for statistical analysis and subgroup comparison., Results: Out of 400 patients, 360 (90%) were found to have triggers. The mean headache intensity on visual analog scale (VAS) was 6.7. The most common trigger factor was emotional stress among both males and females. There was a statistically significant difference in the frequency of trigger factors between men and women for emotional stress, sunlight, sleep deprivation/insomnia, noise, weather change, studying, fried food, and hypersomnia. Psychiatric comorbidity was found in 29% of individuals, with sleep disorder being the most common., Conclusions: TTH has been an underrated diagnosis despite being an extremely common disorder. The trigger factors are less studied and their interactions are lesser known. The diagnostic criteria as per ICHD 3 make TTH a diagnosis of exclusion, rather than a positive diagnosis of inclusion. The trigger factors must be included in the diagnostic criteria in future versions of ICHD and associated psychiatric disorders should be sought for and treated simultaneously for better management and quality of life., (© Journal of the Association of Physicians of India 2011.)

Background: Headache is one of the most frequently reported symptoms in post-COVID patients. The clinical phenotype of COVID-19 headache combines phenotypic features of both tension-type headache (TTH) and migraine. We aimed to assess the effectiveness, side effects and predictors of amitriptyline (AMT) response in a real-world study setting., Methods: We performed an observational multicentric study with a retrospective cohort. All consecutive patients with confirmed COVID-19 infection who received AMT for post-COVID headache from March 2020 to May 2021 were included. Response was evaluated by the reduction in the number of headache days per month (HDM) between weeks 8 and 12, compared with the baseline. We explored which variables were associated with a higher probability of response to AMT., Results: Forty-eight patients were eligible for the study, 40/48 (83.3%) females, aged 46.85 (SD: 13.59) years. Patients had history of migraine 15/48 (31.3%) or TTH 5/48 (10.4%). The mean reduction of HDM was 9.6 (SD: 10.9; 95% CI 6.5, 12.7) days. Only 2/48 (5%) of patients discontinued AMT due to poor tolerability. History of TTH (10.9, 95% CI 1.3, 20.6) and nausea (- 8.5, 95% CI - 14.6, - 2.5) were associated with AMT response., Conclusions: This study provides real-world evidence of the potential benefit of AMT in patients with post-COVID-19 headache, especially in patients with history of TTH and without concomitant nausea., (© 2022. The Author(s).)

Introduction: Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH., Methods: Patients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater., Results: Statistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges' g = 1.01, P = .001; and Headache Disability Inventory: Hedges' g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges' g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges' g = 1.13, P = .18)., Conclusions: Combined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings., (Copyright © 2020 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Nitric oxide (NO) is an important autocrine and paracrine signaling molecule that plays a crucial role in cardiovascular physiology and pathology regulation. NO is an important molecule involved in regulation of cerebral and extra cerebral cranial blood flow and arterial diameters. Reduced bioavailability of NO in the endothelium is an important precursor for impaired vasodilation and arterial hypertension (AH). Furthermore, NO is involved in nociceptive processing. A NO-induced biphasic response with immediate and a delayed headache is typical for chronic tension-type headaches (TTH) in humans. The aim was to study the association of allelic variants and genotypes of the single nucleotide variant (SNV) rs3782218 of the NOS1 gene with the TTH and AH overlap syndrome development in middle age adults., Materials and Methods: We observed 91 Caucasian participants who resided in Krasnoyarsk city: group 1 (TTH and AH overlap syndrome)-30 patients; group 2 (AH without headache)-30 patients; group 3 (control)-31 healthy volunteers. The diagnosis of AH was based on criteria of the European Society of Cardiology and the European Society of Hypertension (2018) и criteria of the Russian Society of Cardiology (2020). Diagnosis of TTH was based on criteria of the International Classification of Headache Disorders (2018). Real-time polymerase chain reaction was used for the determination of allelic variants and genotypes of the SNV rs3782218 of the NOS1 gene in all groups of participants., Results: The frequency of the minor allele T of rs3782218 was statistically significantly higher by 16.7 times in group 1 (TTH and AH) compared to group 3 (control): 26.7% versus 1.6%, respectively ( p -value = 0.000065) and 3.2 times higher in group 1 (TTH and AH) compared to group 2 (AH without headache): 26.7% versus 8.3%, respectively ( p -value = 0.008). The frequency of the heterozygous (CT) genotype was statistically significantly higher in group 1 (TTH and AH) compared to group 3 (control): 40.0% versus 3.2% ( p -value = 0.000454) and in group 1 (TTH and AH) compared to group 2 (AH without headache): 40.0% versus 16.7% ( p -value = 0.045). The minor allele T was statistically significantly associated with a high risk of developing the TTH and AH overlap syndrome compared with the controls (odds ratio (OR) = 22.2 (95% confidential interval (CI): 2.8-173.5)) and compared with AH without headache (OR = 4.0 (95% CI: 1.4-11.8)). Although the frequency of the minor allele T was 5.2 times higher in group 2 (AH without headache) compared with group 3 (control), there were not statistically significantly differences ( p -value = 0.086)., Conclusion: Thus, the minor allele T of rs3782218 of the NOS1 gene is an important genetic biomarker for a high risk of developing the TTH and AH overlap syndrome in hypertensive patients.

Purpose of Review: In this review, the role of the autonomic nervous system in tension-type headache and migraine is reviewed., Recent Findings: A pathophysiological model for tension-type headache is proposed that is compatible with most physiological and behavioral literature. A treatment protocol is described that follows from this model. For migraine, incorporating autonomic factors into the pathophysiology offers rationales for behavioral interventions that have been shown to be useful in migraine treatment and a biofeedback protocol is proposed., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Chronic tension-type headache is the primary headache with the highest prevalence. The present study is aimed at analyzing the associations between patient self-efficacy and headache impact with pain characteristics, kinesiophobia, anxiety sensitivity, and physical activity levels in subjects with chronic tension-type headache., Materials and Methods: An observational descriptive study was carried out. A total sample of 42 participants was recruited at university environment with diagnosis of tension-type headache. Headache characteristics (frequency, intensity, and duration), physical activity levels, pain related-self-efficacy, kinesiophobia, anxiety sensitivity, and headache impact were measured., Results: The HIT-6 (61.05 ± 6.38) score showed significant moderate positive correlations with the ASI-3 score (17.64 ± 16.22; r = 0.47) and moderate negative correlations with the self-efficacy in the domains of pain management (31.9 ± 10.28; r = -0.43) and coping with symptoms (53.81 ± 14.19; r = -0.47). ASI-3 score had a negative large correlation with self-efficacy in the domains of pain management ( r = -0.59), physical function (53.36 ± 7.99; r = -0.55), and coping with symptoms ( r = -0.68). Physical activity levels showed positive moderate correlations with the self-efficacy in the domain of physical function ( r = 0.41). Linear regression models determined that the self-efficacy and anxiety sensitivity with showed a significant relationship with the HIT-6 score ( R 2 = 0.262; p = 0.008) and with the ASI-3 score ( R 2 = 0.565; p < 0.001). In addition, no correlations were found between pain intensity, duration or frecuency with psychosocial factors, or headache impact., Conclusions: The present study showed that patients with chronic tension-type headache had a great negative impact on daily tasks and physical activity levels, which were associated with higher anxiety levels and lower self-efficacy., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2022 Ángel González de la Flor et al.)

Background and Objectives: Tension type headache is one of the costliest primary headaches which can cause a significant impact on an individual's life. Healthcare professionals are exposed to multiple trigger factors which give rise to an increase in headache frequency, most notable reasons being sleep disturbances, stress and untimely food habits. With this background, we conducted this study of detailed clinical profile and trigger factors among the 2050 subjects (MBBS students: 909, BDS students: 323, nursing students: 268, postgraduates students and staff: 550) in our medical institute., Materials and Methods: Subjects were given questionnaires on headache and were instructed to give the details of their clinical symptoms along with relevant questions on trigger factors. The assessment tools used were the Visual Analogue Scale (VAS) and Migraine Disability Assessment Scale (MIDAS)., Results: Out of 2050 subjects, 464 patients suffered from tension type headache. Overall prevalence of tension type headache was 22.6%. Prevalence was higher in females (57.9%) as compared to males (42.1%). Headache experienced by majority of the student population was unilateral (31.4%), pulsating type (51.6%) and of moderate intensity (77.1%). Common associated symptoms were nausea associated with other factors (40%) and photophobia and phonophobia (18.6%). Stress (72.1%) and decreased sleep (49.4%) were the most common triggering factors. Practice of self-medication was reported by 80.2% of subjects., Conclusion: Our study noted a high frequency of trigger factors in medical professionals, the most common triggering factors being stress and disturbed sleep. To our knowledge this is the first large study to evaluate headache and specifically tension type headache among medical professionals., Competing Interests: None

Background: Headache, a highly prevalent neurological disorder, has consistently been linked with an elevated risk of dementia. However, most studies are focused on the relationship with migraine in limited age groups. Therefore, the objective of this research was to look at the link between various type of headaches and dementias based on longitudinal population-based data., Methods and Results: Participants diagnosed with headache from 2002 to 2005 were selected and major covariates were collected. The diagnoses of Alzheimer's disease, vascular dementia, and other dementias were observed from 2006 until 2013. The adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of dementias according to headache type were calculated by Cox proportional hazards regression. A number of 470,652 participants were observed for a mean of 7.6 years (standard deviation: 1.2), for approximately 3.6 million person-years. Both tension type headache (TTH) and migraine elevated the risk of all-cause dementias (TTH, aHR 1.18, 95% CI 1.13-2.24; migraine, aHR 1.18, 95% CI 1.13-2.24). Headaches had a greater influence in females and non-smokers as a risk factor of dementias. Patients with migraine who consumed alcohol had a higher risk of dementia, however this was not true with TTH patients. Among participants without comorbidities, TTH patients were more susceptible to dementia than migraine patients. Headache patients had a higher proportion of females regardless of headache type and approximately 1.5 times more individuals had three or more comorbidities compared to those without headache., Conclusions: Headache could be an independent predictor for subsequent dementia risk. Future studies should focus on clarifying pathogenic pathways and possible dementia-related preventive measures in headache populations., Competing Interests: The authors have declared that no competing interests exist.

Objective: Evidence supports that tension-type headache (TTH) involves complex underlying mechanisms. The current study aimed to quantify potential multivariate relationships between headache-related, psychophysical, psychological and health-related variables in patients with TTH using network analysis., Methods: Demographic (age, height, weight), headache-related (intensity, frequency, duration, and headache-related disability), psychological and emotional (Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index), psycho-physical (pressure pain thresholds [PPTs] and myofascial trigger points) and health-related variables (SF-36 questionnaire) were collected in 169 TTH patients. Network connectivity analysis was unsupervised conducted to quantify the adjusted correlations between the modelled variables and to assess their centrality indices (i.e., the connectivity with other symptoms in the network and the importance in the modelled network)., Results: The connectivity network showed local associations between psychophysical and headache-related variables. Multiple significant local positive correlations between PPTs were observed, being the strongest weight between PPTs over the cervical spine and temporalis area ([Formula: see text]: 0.41). The node with the highest strength, closeness and betweenness centrality was depressive levels. Other nodes with high centrality were vitality and headache intensity., Discussion: This is the first study applying a network analysis to understand the connections between headache-related, psychophysical, psychological and health-related variables in TTH. Current findings support a model on how the variables are connected, albeit in separate clusters. The role of emotional aspects, such as depression, is supported by the network. Clinical implications of the findings, such as developing TTH treatments strategies targeting these most important variables, are discussed., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: More than half of children and adolescents have experienced headache within the last 3 months. Several risk factors for headache have been identified, including obesity and lack of sleep. The association between screen time and headache in children and adolescents is sparsely investigated. The aim of this study was to assess this association and evaluate if it varied according to headache diagnosis., Method: This cross-sectional study was performed at the tertiary pediatric outpatient clinic for headache at Herlev University Hospital. A total of 139 participants who answered a questionnaire on lifestyle factors and their daily living were included. Diagnoses of migraine and tension-type headache (TTH) were made according to the International Classification of Headache Disorders-3. Children with both migraine and TTH were allocated to a mixed headache group. We differentiated between total, leisure, and school-related screen time., Results: The mean age was 13.20 ± 3.38 years and 53.2% were girls. Note that 25.2% were diagnosed with migraine without aura, 23.0% migraine with aura, 28.1% TTH, 15.8% mixed headache, and 7.9% had an unclassified headache diagnosis at the time of inclusion. There was no statistically significant difference in screen time across the five headache groups. An association between screen time and headache frequency was found in children with migraine with aura., Conclusion: In this study, we investigated the association between screen time and headache in children and adolescents. More screen time was associated with more frequent headaches in children with migraine with aura. Future prospective studies are needed to determine the causality of this association., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: The current study aimed to investigate the association of temporomandibular disorders (TMD)-related pain with the presence of migraine or tension-type headaches (TTH) over a follow-up period of 11 years., Methods: Data sets from Finnish national health surveys, the Health 2000 Survey (baseline), and the Health 2011 Survey (follow-up) were utilized. Study participants are undergoing clinical TMD examination at baseline and answering questions related to the presence of migraine and TTH at follow-up were included in the study (n = 530). For analyses, the study sample was divided into two data sets: One with those excluded suffering from migraine at baseline (Data set I, n = 345), and the other excluding those having TTH at baseline (Data set II, n = 464)., Results: Based on logistic regression modelling, no consistent association between TMD-related pain and the presence of migraine was observed, although jTMD associated with elevated estimates for migraine. However, participants with muscle-related TMD pain (mTMD) at baseline had markedly higher odds for having TTH at follow-up than participants without mTMD at baseline (OR 2.1, 95% CI 1.2-3.8). Joint-related TMD pain (jTMD) at baseline was inversely associated with the presence of TTH at follow-up (OR 0.4, 95% CI 0.1-1.3)., Conclusion: Contrasting patterns of the associations of TMD-related pain with different severe headaches point towards a more thorough and systematic research approach are needed to understand the mechanisms behind these associations., (© 2021 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Background: Clinical presentation is the key to the diagnosis of patients with migraine and tension-type headache, but features may overlap when both become chronic. Psychophysical parameters may distinguish both conditions. We aimed to compare psychophysical aspects of patients with chronic migraine, chronic tension-type headache and headache-free controls, and to determine whether these can predict headache frequency., Methods: An examiner blinded to the diagnosis assessed 100 participants (chronic migraine (n = 38), chronic tension-type headache (n = 31) and controls (n = 31)). Assessed variables included painful area, pressure pain thresholds, temporal summation, cervical range of motion, neck posture, headache and neck impact, quality of life, and kinesiophobia. Comparison between groups was performed with one-way ANOVA and multiple linear regression was used to assess the headache frequency predictors., Results: We found differences of both headache groups compared to controls ( p  < 0.01), but not between headache groups. Neck disability was a significant predictor of headache frequency for chronic tension-type headache (adjusted R 2  = 0.14; β = 0.43; p  = 0.03) and chronic migraine (adjusted R 2  = 0.18; β = 0.51; p  < 0.01)., Conclusions: Chronic tension-type headache and chronic migraine showed similar psychophysical results, but were significantly worse when compared to controls. The psychophysical examination did not discriminate between headache types. The variable best explaining headache frequency for both headache types was neck disability.

Purpose of Review: To critically evaluate the recent literature on cognitive impairment and headache., Recent Findings: Neurocognitive symptoms are prevalent, debilitating, and occur often with both primary and secondary headache disorders. This is a "narrative review of the current literature in PubMed on cognitive function and headache." Migraine is associated with cognitive impairment years before a migraine diagnosis. In young and middle-aged adults, migraine is associated with deficits in attention, executive function, processing speed, and memory. It is unlikely that migraine is associated with dementia. Although methodologically difficult to assess, there does not seem to be an association between tension-type headache and cognitive dysfunction. In early to midlife, cluster headache seems to be associated with executive dysfunction. Several secondary headache syndromes relevant to clinicians managing headache disorders are associated with poorer cognitive performance or distinctive cognitive patterns, including those attributed to chronic cerebral or systemic vascular disorders, trauma, and derangements of intracranial pressure and volume, including frontotemporal brain sagging syndrome., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Information technology advances may help in conducting epidemiological studies using web-based surveys. Questionnaire-based headache diagnosis should be validated against the doctor's diagnosis. This study aimed to develop and validate a web-based diagnostic questionnaire for migraine, probable migraine (PM), and tension-type headache (TTH). We constructed a seven-item questionnaire for diagnosing migraine, PM, and TTH. A web-based survey was conducted among adults aged 20-59 years; migraine, PM, and TTH were diagnosed based on the responses. Validation interview was performed via telephone by a neurologist within 1 month after the web-based interview. Finally, 256 participants completed both web-based survey and validation interview. Of them, 121 (47.3%), 65 (25.4%), 61 (23.8%), and 9 (3.5%) were diagnosed with migraine, PM, TTH, and unclassified headache (UH), respectively in the web-based survey, whereas 119 (46.5%), 60 (23.4%), 74 (28.9%), 2 (0.8%), and 1 (0.4%) were diagnosed with migraine, PM, TTH, UH, and primary stabbing headache, respectively in the validation interview. The best agreement was found in migraine (sensitivity: 92.6%; specificity: 94.8%; kappa coefficient: 0.875), followed by TTH (sensitivity: 78.4%; specificity: 98.4%; kappa coefficient: 0.809). PM showed the least agreement (sensitivity: 85.0%; specificity: 92.9%; kappa coefficient: 0.757). In conclusion, our questionnaire is valid in identifying these headache disorders., (© 2022. The Author(s).)

Infantile regurgitation is one of the most common discomforts in the first months of life. Infantile colic and, in older children, functional dyspepsia have been linked to migraine. To date, this is the first study to investigate a possible association between infantile regurgitation and primary headaches in children. This is a case-control study of 195 children aged 6-17 years, with primary headache (migraine, or tension type headache) in 5 European paediatric hospitals. The control group is composed of 240 same-aged children attending with minor injuries during the same period - February 1st 2020 to December 1st 2020. A structured questionnaire identified a history of infantile regurgitation and other functional gastrointestinal disorders for case and control participants. The outcome was the difference in the prevalence of infantile regurgitation among children with or without a diagnosis of primary headache. The analysis showed a significant association between infantile regurgitation and migraine (OR = 1.88, CI 95 = 1.01-3.4, p = 0.04). No association was found between infantile regurgitation and tension type headache (p = 0.33). Subgroup analysis confirmed that the association was only significant for migraine without aura (OR = 2.3, CI 95 = 1.2-4.4, p = 0.01). In a further subgroup analysis, the presence of functional dyspepsia, irritable bowel syndrome and abdominal migraine was associated with migraine without aura., Conclusion: The presence of migraine among children aged 6-17 was associated with a history of infantile regurgitation. Additional longitudinal studies are required to confirm whether infantile regurgitation could be considered as a precursor of migraine., What Is Known: • Children suffering from functional gastrointestinal disorders are more likely to be suffering from migraine and tension-type headache as well. • Children suffering from primary headache are more likely to have had infantile colic in their first six month of life., What Is New: • It is the first study to find an association between migraine and infantile regurgitation in children. • These findings could have an impact on the diagnosis and therapeutics of both migraine and infantile regurgitation., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults?, Types of Studies Reviewed: The protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 6 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation., Results: Nine of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 7 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 1.94 [95% CI, 0.56 to 6.76] to OR, 7.61 [95% CI, 1.84 to 31.48]), migraines (OR, 4.14 [95% CI, 1.38 to 12.43] to OR, 5.44 [95% CI, 3.61 to 8.21]), and chronic headaches (OR, 40.40 [95% CI, 8.67 to 188.15] to OR, 95.93 [95% CI, 12.53 to 734.27]) were calculated. Articular TMDs without pain were evaluated in 2 articles, and both did not show positive association with tension-type headache nor migraine. Three studies were classified as moderate risk of bias and 6 as low risk of bias. The certainty of evidence varied between very low and low., Conclusions and Practical Implications: Recognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist., (Copyright © 2022 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: Migraines and tension-type headaches (TTH) are primary headaches that can be screened with the Headache Screening Questionnaire (HSQ). However, the HSQ scoring algorithms rely on manual calculation, which is laborious and carries a risk of human error., Objective: To develop an automated tool to calculate the output of the HSQ scoring algorithm and to determine the agreement between the automated and manual calculation., Design: A cross-sectional design was used., Methods: The automated tool was developed as a Microsoft Excel spreadsheet that was tested with all possible answers for the HSQ. An experienced researcher had access to answers to the HSQ from 163 people with headaches and manually applied the migraine and TTH algorithms to obtain the final scores and classifications. After that, the same answers were uploaded into the spreadsheet and scored by the automated algorithm. The agreement between manual and automated scoring was calculated for the total score using Intraclass Correlation Coefficients (ICC 2,1 ), Standard Error of Measurement (SEM), and Limits of Agreement. The agreement between the classification obtained by the automated tool and the classification obtained by manual calculation for migraine and TTH was calculated using weighted Kappas (k-values)., Results: The total score showed excellent agreement for migraine (ICC = 0.97, 95% CI = 0.96-0.98, SEM = 0.36) and good agreement for TTH (ICC = 0.87, 95% CI = 0.82-0.90, SEM = 0.55). The classification demonstrated excellent agreement for migraine (k-value = 0.93, 95% CI = 0.89-0.97) and for TTH (k-value = 0.78, 95% CI = 0.70-0.86)., Conclusion: Implementation of the automated tool in clinical practice is suggested when using the HSQ to screen patients with primary headaches., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The bulk of patients with primary headaches HA (cephalalgias) are observed in primary care. The optimal diagnostic algorithm implies the exclusion of potentially dangerous causes of HA and secondary cephalalgias requiring specific treatment. Verification of the form of primary HA is carried out clinically, does not require additional diagnostic methods and is based on the use of the criteria of the International Classification of Headache Disorders. Among all cephalalgias in general clinical practice, the vast majority of cases are represented by four forms: migraine, tension type headache, cluster headache, and medication overuse headache. The complex application of modern methods of pharmacological and non-pharmacological treatment with the use of preventive strategies ensures high efficiency in the management of patients with HA.

Background: Primary headache is a disorder with a high incidence and low diagnostic accuracy; the incidence of migraine and tension-type headache ranks first among primary headaches. Artificial intelligence (AI) decision support systems have shown great potential in the medical field. Therefore, we attempt to use machine learning to build a clinical decision-making system for primary headaches., Methods: The demographic data and headache characteristics of 173 patients were collected by questionnaires. Decision tree, random forest, gradient boosting algorithm and support vector machine (SVM) models were used to construct a discriminant model and a confusion matrix was used to calculate the evaluation indicators of the models. Furthermore, we have carried out feature selection through univariate statistical analysis and machine learning., Results: In the models, the accuracy, F1 score were calculated through the confusion matrix. The logistic regression model has the best discrimination effect, with the accuracy reaching 0.84 and the area under the ROC curve also being the largest at 0.90. Furthermore, we identified the most important factors for distinguishing the two disorders through statistical analysis and machine learning: nausea/vomiting and photophobia/phonophobia. These two factors represent potential independent factors for the identification of migraines and tension-type headaches, with the accuracy reaching 0.74 and the area under the ROC curve being at 0.74., Conclusions: Applying machine learning to the decision-making system for primary headaches can achieve a high diagnostic accuracy. Among them, the discrimination effect obtained by the integrated algorithm is significantly better than that of a single learner. Second, nausea/vomiting, photophobia/phonophobia may be the most important factors for distinguishing migraine from tension-type headaches., Competing Interests: The authors declare there are no competing interests., (©2022 Liu et al.)

Abstract: Roughly 90% of the U.S. population will develop a headache within their lifetime, and headache disorders account for more disability-adjusted life-years than all other neurologic disorders combined. Among primary headache disorders, the two most common are tension-type headache and migraine, with migraine identified as the most disabling. Here, the authors describe the importance of differentiating primary and secondary headache disorders and discuss the pathophysiology; clinical assessment; and outpatient management of the debilitating migraine headache, summarizing both acute and prophylactic treatment strategies that can substantially reduce associated disability., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Headaches are very common in children. The patients often have mild symptoms, but on occasion may have severe, secondary headaches. The present study aimed to clarify the details of children with headaches seen at the outpatient clinic of a pediatric neurological department., Methods: The present, retrospective observational study was conducted at a tertiary pediatric hospital in Japan and enrolled children referred to the neurology department outpatient clinic for headache between April 2018 and March 2021., Results: In total, 113 cases of headache were examined; of these, 99 (87.6%) were primary headaches, one case (0.9%) was a secondary headache, and 13 (11.5%) were unclassified or unspecified. There were 46 cases (40.7%) of tension-type headache (TTH), both confirmed and suspected, 30 cases (26.5%) of migraine, and 23 cases (20.4%) of a combination of the TTH and migraine. One case of secondary headache was attributed to an infection. Arachnoid cysts were found in seven patients (7.8%). Acute drug treatments were administered to 93 patients (82.3%), with acetaminophen being the most common drug, followed by ibuprofen. Prophylactic drug treatments were administered to 39 patients (34.5%), with goreisan (a Chinese herbal medicine containing Alisma orientale, Poria cocos, Polyporus umbellatus, Atractylodes lancea, and Cinnamomum cassia) being the most common (41%)., Conclusions: Few cases of secondary headache and none of emergency headache were diagnosed. The prevalence of arachnoid cysts was higher than in the general pediatric population, suggesting that arachnoid cysts might be associated with headache., (© 2022 Japan Pediatric Society.)