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Drug Treatment for Episodic and Chronic Tension-Type Headache

  • Chapter
Pharmacological Management of Headaches

Part of the book series: Headache ((HEAD))

Abstract

Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Simple analgesics are recommended for treatment of episodic tension-type headache. There is evidence for efficacy of ibuprofen 200–800 mg, aspirin 500–1000 mg, paracetamol 1000 mg, ketoprofen 25 mg, naproxen 375–550 mg and diclofenac 12.5–100 mg. Combinations containing caffeine are recommended as drugs of second choice. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache (MOH). Triptans are not indicated in the management of tension-type headache. The tricyclic antidepressant amitriptyline 30–75 mg/day is drug of first choice for the prophylactic treatment of chronic tension-type headache. Mirtazapine 15–30 mg/day and venlafaxine 150 mg/day are drugs of second choice.

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References

  1. Vos T, Flaxman AD, Naghavi M et al (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2163–2196

    Article  PubMed  Google Scholar 

  2. Schwartz BS, Stewart WF, Lipton RB (1997) Lost workdays and decreased work effectiveness associated with headache in the workplace. J Occup Environ Med 39:320–327

    Article  CAS  PubMed  Google Scholar 

  3. Stovner L, Hagen K, Jensen R et al (2007) The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 27:193–210

    Article  PubMed  Google Scholar 

  4. Headache Classification Subcommittee of the International Headache Society (2013) The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33:629–808

    Article  Google Scholar 

  5. Bendtsen L, Fernandez-de-la-Penas C (2011) The role of muscles in tension-type headache. Curr Pain Headache Rep 15:451–458

    Article  PubMed  Google Scholar 

  6. Bezov D, Ashina S, Jensen R, Bendtsen L (2011) Pain perception studies in tension-type headache. Headache 51:262–271

    Article  PubMed  Google Scholar 

  7. Buchgreitz L, Lyngberg AC, Bendtsen L, Jensen R (2008) Increased pain sensitivity is not a risk factor but a consequence of frequent headache: a population-based follow-up study. Pain 137:623–630

    Article  CAS  PubMed  Google Scholar 

  8. Bendtsen L (2000) Central sensitization in tension-type headache – possible pathophysiological mechanisms. Cephalalgia 20:486–508

    Article  CAS  PubMed  Google Scholar 

  9. Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J (2010) EFNS guideline on the treatment of tension-type headache – report of an EFNS task force. Eur J Neurol 17:1318–1325

    CAS  PubMed  Google Scholar 

  10. Russell MB, Rasmussen BK, Brennum J, Iversen HK, Jensen R, Olesen J (1992) Presentation of a new instrument: the diagnostic headache diary. Cephalalgia 12:369–374

    Article  CAS  PubMed  Google Scholar 

  11. Manzoni GC, Torelli P (2009) Chronic migraine and chronic tension-type headache: are they the same or different? Neurol Sci 30(Suppl 1):S81–S84

    Article  PubMed  Google Scholar 

  12. Bendtsen L, Munksgaard S, Tassorelli C et al (2014) Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment. Results from a multicentre, multinational study (COMOESTAS project). Cephalalgia 34:426–433

    Article  CAS  PubMed  Google Scholar 

  13. Katsarava Z, Jensen R (2007) Medication-overuse headache: where are we now? Curr Opin Neurol 20:326–330

    Article  PubMed  Google Scholar 

  14. Olesen J, Bousser MG, Diener HC et al (2006) New appendix criteria open for a broader concept of chronic migraine. Cephalalgia 26:742–746

    Article  CAS  PubMed  Google Scholar 

  15. Steiner TJ, Lange R, Voelker M (2003) Aspirin in episodic tension-type headache: placebo-controlled dose-ranging comparison with paracetamol. Cephalalgia 23:59–66

    Article  CAS  PubMed  Google Scholar 

  16. Schachtel BP, Thoden WR, Konerman JP, Brown A, Chaing DS (1991) Headache pain model for assessing and comparing the efficacy of over-the-counter analgesic agents. Clin Pharmacol Ther 50:322–329

    Article  CAS  PubMed  Google Scholar 

  17. Migliardi JR, Armellino JJ, Friedman M, Gillings DB, Beaver WT (1994) Caffeine as an analgesic adjuvant in tension headache. Clin Pharmacol Ther 56:576–586

    Article  CAS  PubMed  Google Scholar 

  18. Schachtel BP, Furey SA, Thoden WR (1996) Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache. J Clin Pharmacol 36:1120–1125

    Article  CAS  PubMed  Google Scholar 

  19. Packman B, Packman E, Doyle G et al (2000) Solubilized ibuprofen: evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache. Headache 40:561–567

    Article  CAS  PubMed  Google Scholar 

  20. Prior MJ, Cooper KM, May LG, Bowen DL (2002) Efficacy and safety of acetaminophen and naproxen in the treatment of tension-type headache. A randomized, double-blind, placebo-controlled trial. Cephalalgia 22:740–748

    Article  CAS  PubMed  Google Scholar 

  21. Steiner TJ, Lange R (1998) Ketoprofen (25 mg) in the symptomatic treatment of episodic tension-type headache: double-blind placebo-controlled comparison with acetaminophen (1000 mg). Cephalalgia 18:38–43

    Article  CAS  PubMed  Google Scholar 

  22. Dahlöf CGH, Jacobs LD (1996) Ketoprofen, paracetamol and placebo in the treatment of episodic tension-type headache. Cephalalgia 16:117–123

    Article  PubMed  Google Scholar 

  23. Mehlisch DR, Weaver M, Fladung B (1998) Ketoprofen, acetaminophen, and placebo in the treatment of tension headache. Headache 38:579–589

    Article  CAS  PubMed  Google Scholar 

  24. Miller DS, Talbot CA, Simpson W, Korey A (1987) A comparison of naproxen sodium, acetaminophen and placebo in the treatment of muscle contraction headache. Headache 27:392–396

    Article  CAS  PubMed  Google Scholar 

  25. Martinez-Martin P, Raffaelli E Jr, Titus F et al (2001) Efficacy and safety of metamizol vs. acetylsalicylic acid in patients with moderate episodic tension-type headache: a randomized, double-blind, placebo- and active-controlled, multicentre study. Cephalalgia 21:604–610

    Article  CAS  PubMed  Google Scholar 

  26. Von Graffenried B, Nuesch E (1980) Non-migrainous headache for the evaluation of oral analgesics. Br J Clin Pharmacol 10(Suppl 2):225S–231S

    Article  PubMed Central  Google Scholar 

  27. Diamond S (1983) Ibuprofen versus aspirin and placebo in the treatment of muscle contraction headache. Headache 23:206–210

    Article  CAS  PubMed  Google Scholar 

  28. Langemark M, Olesen J (1987) Effervescent ASA versus solid ASA in the treatment of tension headache. A double-blind, placebo controlled study. Headache 27:90–95

    Article  CAS  PubMed  Google Scholar 

  29. Kubitzek F, Ziegler G, Gold MS, Liu JM, Ionescu E (2003) Low-dose diclofenac potassium in the treatment of episodic tension-type headache. Eur J Pain 7:155–162

    Article  CAS  PubMed  Google Scholar 

  30. Schachtel BP, Thoden WR (1988) Onset of action of ibuprofen in the treatment of muscle-contraction headache. Headache 28:471–474

    Article  CAS  PubMed  Google Scholar 

  31. van Gerven JM, Schoemaker RC, Jacobs LD et al (1996) Self-medication of a single headache episode with ketoprofen, ibuprofen or placebo, home-monitored with an electronic patient diary. Br J Clin Pharmacol 42:475–481

    Article  PubMed  Google Scholar 

  32. Pini LA, Del BE, Zanchin G et al (2008) Tolerability and efficacy of a combination of paracetamol and caffeine in the treatment of tension-type headache: a randomised, double-blind, double-dummy, cross-over study versus placebo and naproxen sodium. J Headache Pain 9:367–373

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Harden RN, Rogers D, Fink K, Gracely RH (1998) Controlled trial of ketorolac in tension-type headache. Neurology 50:507–509

    Article  CAS  PubMed  Google Scholar 

  34. Moore RA, Derry S, Wiffen PJ, Straube S, Bendtsen L (2014) Evidence for efficacy of acute treatment of episodic tension-type headache: methodological critique of randomised trials for oral treatments. Pain 155:2220–2228

    Article  PubMed  Google Scholar 

  35. Lange R, Lentz R (1995) Comparison ketoprofen, ibuprofen and naproxen sodium in the treatment of tension-type headache. Drugs Exp Clin Res 21:89–96

    CAS  PubMed  Google Scholar 

  36. Verhagen AP, Damen L, Berger MY, Passchier J, Merlijn V, Koes BW (2006) Is any one analgesic superior for episodic tension-type headache? J Fam Pract 55:1064–1072

    PubMed  Google Scholar 

  37. Ward N, Whitney C, Avery D, Dunner D (1991) The analgesic effects of caffeine in headache. Pain 44:151–155

    Article  CAS  PubMed  Google Scholar 

  38. Diamond S, Balm TK, Freitag FG (2000) Ibuprofen plus caffeine in the treatment of tension-type headache. Clin Pharmacol Ther 68:312–319

    Article  CAS  PubMed  Google Scholar 

  39. Diener HC, Pfaffenrath V, Pageler L, Peil H, Aicher B (2005) The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Cephalalgia 25:776–787

    Article  CAS  PubMed  Google Scholar 

  40. Cerbo R, Centonze V, Grazioli I et al (2005) Efficacy of a fixed combination of indomethacin, prochlorperazine, and caffeine in the treatment of episodic tension-type headache: a double-blind, randomized, nimesulide-controlled, parallel group, multicentre trial. Eur J Neurol 12:759–767

    Article  CAS  PubMed  Google Scholar 

  41. Scher AI, Lipton RB, Stewart WF, Bigal M (2010) Patterns of medication use by chronic and episodic headache sufferers in the general population: results from the frequent headache epidemiology study. Cephalalgia 30:321–328

    Article  CAS  PubMed  Google Scholar 

  42. Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB (2008) Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache 48:1157–1168

    Article  PubMed  Google Scholar 

  43. Cady RK, Gutterman D, Saiers JA, Beach ME (1997) Responsiveness of non-IHS migraine and tension-type headache to sumatriptan. Cephalalgia 17:588–590

    Article  CAS  PubMed  Google Scholar 

  44. Lipton RB, Cady RK, Stewart WF, Wilks K, Hall C (2002) Diagnostic lessons from the spectrum study. Neurology 58:S27–S31

    Article  CAS  PubMed  Google Scholar 

  45. Brennum J, Brinck T, Schriver L et al (1996) Sumatriptan has no clinically relevant effect in the treatment of episodic tension-type headache. Eur J Neurol 3:23–28

    Article  Google Scholar 

  46. Brennum J, Kjeldsen M, Olesen J (1992) The 5-HT1-like agonist sumatriptan has a significant effect in chronic tension-type headache. Cephalalgia 12:375–379

    Article  CAS  PubMed  Google Scholar 

  47. Mathew N, Ashina M (2005) Acute pharmacotherapy of tension-type headaches. In: Olesen J, Goadsby PJ, Ramadan N, Tfelt-Hansen P, Welch KM (eds) The headaches, 3rd edn. Lippincott Williams Wilkins, Philadelphia, pp 727–733

    Google Scholar 

  48. Langman MJ, Weil J, Wainwright P et al (1994) Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet 343:1075–1078

    Article  CAS  PubMed  Google Scholar 

  49. Bigal ME, Lipton RB (2009) Overuse of acute migraine medications and migraine chronification. Curr Pain Headache Rep 13:301–307

    Article  PubMed  Google Scholar 

  50. Bendtsen L, Bigal ME, Cerbo R et al (2010) Guidelines for controlled trials of drugs in tension-type headache: second edition. Cephalalgia 30:1–16

    Article  CAS  PubMed  Google Scholar 

  51. Lance JW, Curran DA (1964) Treatment of chronic tension headache. Lancet 1:1236–1239

    Article  CAS  PubMed  Google Scholar 

  52. Diamond S, Baltes BJ (1971) Chronic tension headache – treated with amitriptyline – a double-blind study. Headache 11:110–116

    Article  CAS  PubMed  Google Scholar 

  53. Göbel H, Hamouz V, Hansen C et al (1994) Chronic tension-type headache: amitriptyline reduces clinical headache-duration and experimental pain sensitivity but does not alter pericranial muscle activity readings. Pain 59:241–249

    Article  PubMed  Google Scholar 

  54. Pfaffenrath V, Diener HC, Isler H et al (1994) Efficacy and tolerability of amitriptylinoxide in the treatment of chronic tension-type headache: a multi-centre controlled study. Cephalalgia 14:149–155

    Article  CAS  PubMed  Google Scholar 

  55. Bendtsen L, Jensen R, Olesen J (1996) A non-selective (amitriptyline), but not a selective (citalopram), serotonin reuptake inhibitor is effective in the prophylactic treatment of chronic tension-type headache. J Neurol Neurosurg Psychiatry 61:285–290

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW (2001) Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA 285:2208–2215

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Langemark M, Loldrup D, Bech P, Olesen J (1990) Clomipramine and mianserin in the treatment of chronic tension headache. A double-blind, controlled study. Headache 30:118–121

    Article  CAS  PubMed  Google Scholar 

  58. Fogelholm R, Murros K (1992) Tizanidine in chronic tension-type headache: a placebo controlled double-blind cross-over study. Headache 32:509–513

    Article  CAS  PubMed  Google Scholar 

  59. Bendtsen L, Jensen R (2004) Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology 62:1706–1711

    Article  CAS  PubMed  Google Scholar 

  60. Krishnan A, Silver N (2009) Headache (chronic tension-type). BMJ Clin Evid pii: 1205

    Google Scholar 

  61. Zissis N, Harmoussi S, Vlaikidis N et al (2007) A randomized, double-blind, placebo-controlled study of venlafaxine XR in out-patients with tension-type headache. Cephalalgia 27:315–324

    Article  CAS  PubMed  Google Scholar 

  62. Singh NN, Misra S (2002) Sertraline in chronic tension-type headache. J Assoc Physicians India 50:873–878

    CAS  PubMed  Google Scholar 

  63. Moja PL, Cusi C, Sterzi RR, Canepari C (2005) Selective serotonin re-uptake inhibitors (SSRIs) for preventing migraine and tension-type headaches. Cochrane Database Syst Rev (3):CD002919

    Google Scholar 

  64. Murros K, Kataja M, Hedman C et al (2000) Modified-release formulation of tizanidine in chronic tension-type headache. Headache 40:633–637

    Article  CAS  PubMed  Google Scholar 

  65. Lindelof K, Bendtsen L (2009) Memantine for prophylaxis of chronic tension-type headache–a double-blind, randomized, crossover clinical trial. Cephalalgia 29:314–321

    Article  CAS  PubMed  Google Scholar 

  66. Padberg M, de Bruijn SF, de Haan RJ, Tavy DL (2004) Treatment of chronic tension-type headache with botulinum toxin: a double-blind, placebo-controlled clinical trial. Cephalalgia 24:675–680

    Article  CAS  PubMed  Google Scholar 

  67. Relja M, Telarovic S (2004) Botulinum toxin in tension-type headache. J Neurol 251(Suppl 1):12–14

    CAS  Google Scholar 

  68. Rollnik JD, Tanneberger O, Schubert M, Schneider U, Dengler R (2000) Treatment of tension-type headache with botulinum toxin type A: a double-blind, placebo-controlled study. Headache 40:300–305

    Article  CAS  PubMed  Google Scholar 

  69. Schmitt WJ, Slowey E, Fravi N, Weber S, Burgunder JM (2001) Effect of botulinum toxin A injections in the treatment of chronic tension-type headache: a double-blind, placebo-controlled trial. Headache 41:658–664

    Article  CAS  PubMed  Google Scholar 

  70. Schulte-Mattler WJ, Krack P, BoNTTH Study Group (2004) Treatment of chronic tension-type headache with botulinum toxin A: a randomized, double-blind, placebo-controlled multicenter study. Pain 109:110–114

    Article  CAS  PubMed  Google Scholar 

  71. Smuts JA, Baker MK, Smuts HM (1999) Prophylactic treatment of chronic tension-type headache using botulinum toxin type A. Eur J Neurol 6(Suppl):S99–S102

    Article  Google Scholar 

  72. Göbel H, Lindner V, Krack PK (1999) Treatment of chronic tension-type headache with botulinum toxin, a double blind, placebo-controlled clinical trial. Cephalalgia 19:455

    Google Scholar 

  73. Silberstein SD, Gobel H, Jensen R et al (2006) Botulinum toxin type A in the prophylactic treatment of chronic tension-type headache: a multicentre, double-blind, randomized, placebo-controlled, parallel-group study. Cephalalgia 26:790–800

    Article  CAS  PubMed  Google Scholar 

  74. Kokoska MS, Glaser DA, Burch CM, Hollenbeak CS (2004) Botulinum toxin injections for the treatment of frontal tension headache. J Headache Pain 5:103–109

    Article  CAS  PubMed Central  Google Scholar 

  75. Harden RN, Cottrill J, Gagnon CM et al (2009) Botulinum toxin a in the treatment of chronic tension-type headache with cervical myofascial trigger points: a randomized, double-blind, placebo-controlled pilot study. Headache 49:732–743

    Article  PubMed  Google Scholar 

  76. Straube A, Empl M, Ceballos-Baumann A, Tolle T, Stefenelli U, Pfaffenrath V (2008) Pericranial injection of botulinum toxin type A (Dysport) for tension-type headache – a multicentre, double-blind, randomized, placebo-controlled study. Eur J Neurol 15:205–213

    Article  CAS  PubMed  Google Scholar 

  77. Bendtsen L, Buchgreitz L, Ashina S, Jensen R (2007) Combination of low-dose mirtazapine and ibuprofen for prophylaxis of chronic tension-type headache. Eur J Neurol 14:187–193

    Article  CAS  PubMed  Google Scholar 

  78. Lampl C, Marecek S, May A, Bendtsen L (2006) A prospective, open-label, long-term study of the efficacy and tolerability of topiramate in the prophylaxis of chronic tension-type headache. Cephalalgia 26:1203–1208

    Article  CAS  PubMed  Google Scholar 

  79. Mitsikostas DD, Gatzonis S, Thomas A, Ilias A (1997) Buspirone vs amitriptyline in the treatment of chronic tension-type headache. Acta Neurol Scand 96:247–251

    Article  CAS  PubMed  Google Scholar 

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Declaration of Interests

Lars Bendtsen has received honoraria for lectures from MSD, Allergan and Pfizer, serves on the scientific advisory board for Berlin-Chemie, has been a consultant to Reckitt Benckiser and been on Reckitt Benckiser speaker panels and has been principal investigator for Convergence Pharmaceuticals.

Sait Ashina received honoraria for lecturing from Allergan, Nautilus Neurosciences and NeurogesX and served as a consultant for Depomed.

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Authors and Affiliations

  1. Department of Neurology, Danish Headache Centre, Glostrup Hospital, University of Copenhagen, DK-2600 Glostrup, Copenhagen, Denmark

    Lars Bendtsen

  2. Department of Neurology, Headache Program, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Sait Ashina

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  1. Lars Bendtsen
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Correspondence to Lars Bendtsen .

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  1. Department of Neurology, Athens Naval Hospital, Athens, Greece

    Dimos D. Mitsikostas

  2. Department of Neurology, Ghent University Hospital, Ghent, Belgium

    Koen Paemeleire

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Bendtsen, L., Ashina, S. (2016). Drug Treatment for Episodic and Chronic Tension-Type Headache. In: Mitsikostas, D., Paemeleire, K. (eds) Pharmacological Management of Headaches. Headache. Springer, Cham. https://doi.org/10.1007/978-3-319-19911-5_9

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  • DOI: https://doi.org/10.1007/978-3-319-19911-5_9

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