Tension headache prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]
Overview
TTH prevention and prophylactic treatment is generally indicated for chronic TTH and frequent episodic TTH. Data regarding pharmacologic prevention and prophylactic treatment is limited and not well established. Drugs that can be used are; TCA (amitriptyline), SSRI (mirtazapine, venlafaxine), and anticonvulsants (gabapentin, topiramate). Behavioral treatments include; relaxation, biofeedback, and CBT. For patients with frequent episodic or chronic TTH, combined Rx with TCA plus stress management therapy is recommended rather than alone therapy with TCA or behavioral therapy alone. (Grade 2B). For patients with frequent episodic or chronic TTH, having preference for pharmacologic therapy rather than behavioral therapy, TCA with amitriptyline is recommended. (Grade 2B). For patients with frequent episodic or chronic TTH, not needing pharmacologic therapy, electromyography biofeedback combined with relaxation therapy is recommended. (Grade 2B). For patients with frequent episodic or chronic TTH, who cannot tolerate or require more effective treatments such as amitriptyline and biofeedback, accupuncture (Grade 2B) or physical therapy (Grade 2C) is recommended.
Prevention
- TTH prevention and prophylactic treatment is generally indicated for chronic TTH and frequent episodic TTH. Data regarding pharmacologic prevention and prophylactic treatment is limited and not well established. Drugs that can be used are:
- Behavioral treatments include:
- For patients with frequent episodic or chronic TTH, combined Rx with TCA plus stress management therapy is recommended rather than alone therapy with TCA or behavioral therapy alone. (Grade 2B)
- For patients with frequent episodic or chronic TTH, having preference for pharmacologic therapy rather than behavioral therapy, TCA with amitriptyline is recommended. (Grade 2B)
- For patients with frequent episodic or chronic TTH, not needing pharmacologic therapy, electromyography biofeedback combined with relaxation therapy is recommended. (Grade 2B)
- For patients with frequent episodic or chronic TTH, who cannot tolerate or require more effective treatments such as amitriptyline and biofeedback, accupuncture (Grade 2B) or physical therapy (Grade 2C) is recommended.[7]
References
- ↑ Jackson JL, Mancuso JM, Nickoloff S, Bernstein R, Kay C (December 2017). "Tricyclic and Tetracyclic Antidepressants for the Prevention of Frequent Episodic or Chronic Tension-Type Headache in Adults: A Systematic Review and Meta-Analysis". J Gen Intern Med. 32 (12): 1351–1358. doi:10.1007/s11606-017-4121-z. PMC 5698213. PMID 28721535.
- ↑ Ashina S, Bendtsen L, Jensen R (March 2004). "Analgesic effect of amitriptyline in chronic tension-type headache is not directly related to serotonin reuptake inhibition". Pain. 108 (1–2): 108–14. doi:10.1016/j.pain.2003.12.012. PMID 15109513.
- ↑ Bendtsen L, Jensen R (May 2004). "Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache". Neurology. 62 (10): 1706–11. doi:10.1212/01.wnl.0000127282.90920.8c. PMID 15159466.
- ↑ Spira PJ, Beran RG (December 2003). "Gabapentin in the prophylaxis of chronic daily headache: a randomized, placebo-controlled study". Neurology. 61 (12): 1753–9. doi:10.1212/01.wnl.0000100121.58594.11. PMID 14694042.
- ↑ Lampl C, Marecek S, May A, Bendtsen L (October 2006). "A prospective, open-label, long-term study of the efficacy and tolerability of topiramate in the prophylaxis of chronic tension-type headache". Cephalalgia. 26 (10): 1203–8. doi:10.1111/j.1468-2982.2006.01193.x. PMID 16961787.
- ↑ 6.0 6.1 6.2 Rains JC, Penzien DB, McCrory DC, Gray RN (May 2005). "Behavioral headache treatment: history, review of the empirical literature, and methodological critique". Headache. 45 Suppl 2: S92–109. doi:10.1111/j.1526-4610.2005.4502003.x. PMID 15921506.
- ↑ Melchart D, Streng A, Hoppe A, Brinkhaus B, Becker-Witt C, Hammes M, Irnich D, Hummelsberger J, Willich SN, Linde K (December 2005). "The acupuncture randomised trial (ART) for tension-type headache--details of the treatment". Acupunct Med. 23 (4): 157–65. doi:10.1136/aim.23.4.157. PMID 16430123.