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Advances in the pharmacologic treatment of tension-type headache

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Abstract

Tension-type headache (TTH) is the most prevalent form of primary headache in the general population. We discuss advances in the treatment of TTH. We briefly review nonpharmacologic therapies and then focus on current pharmacologic strategies. For acute treatment, the most common interventions involve the use of simple analgesics and anti-inflammatory medications, often taken by the patient without a prescription. For preventive treatment, amitriptyline is the best-studied drug, but nortriptyline, mirtazapine, tizanidine, the selective serotonin reuptake inhibitors, and other medications can be used. We close by discussing potential future therapies, including calcitonin gene-related peptide receptor antagonism, as well as substance P and the nitric oxide pathways.

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References and Recommended Reading

  1. Schwartz BS, Stewart WF, Simon D, Lipton RB: epidemiology of tension-type headache. JAMA 1998, 279:381–383.

    Article  PubMed  CAS  Google Scholar 

  2. Rasmussen BK, Jensen R, Schroll M, Olesen J: Epidemiology of headache in a general population: a prevalence study. J Clin Epidemiol 1991, 44:1147–1157.

    Article  PubMed  CAS  Google Scholar 

  3. Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988, 8(Suppl 7):1–96.

    Google Scholar 

  4. Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders: 2nd Edition. Cephalalgia 2004, 24(Suppl 1):9–160.

    Google Scholar 

  5. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R: Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. Eur J Epidemiol 2005, 20:243–249.

    Article  PubMed  Google Scholar 

  6. Bigal ME, Bigal JM, Betti M, et al.: Evaluation of the impact of migraine and episodic tension-type headache on the quality of life and performance of a university student population. Headache 2001, 41:710–719.

    Article  PubMed  CAS  Google Scholar 

  7. Jensen R: Diagnosis, epidemiology, and impact of tension-type headache. Curr Pain Headache Rep 2003, 7:455–459.

    Article  PubMed  Google Scholar 

  8. Silva HM Jr, Garbelini RP, Teixeira SO, et al.: Effect of episodic tension-type headache on the health-related quality of life in employees of a Brazilian public hospital. Arq Neuropsiquiatr 2004, 62:769–773.

    PubMed  Google Scholar 

  9. Rasmussen BK: Epidemiology of headache. Cephalalgia 1995, 15:45–68.

    PubMed  CAS  Google Scholar 

  10. Sandrini G, Antonaci F, Pucci E, et al.: Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine. Cephalalgia 1994, 14:451–457.

    Article  PubMed  CAS  Google Scholar 

  11. Jensen R, Fuglsang-Frederiksen A: Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population. Electroencephalogr Clin Neurophysiol 1994, 93:175–183.

    Article  PubMed  CAS  Google Scholar 

  12. Lipton RB, Bigal ME, Diamond M, et al.: Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007, 68:343–349.

    Article  PubMed  CAS  Google Scholar 

  13. Ursin H, Endresen IM, Haaland EM, Mjellem N: Sensitization: A Neurobiological Theory for Muscle Pain. New York: Elsevier; 1993:413–427.

    Google Scholar 

  14. Torelli P, Jensen R, Olesen J: Physiotherapy for tension-type headache: a controlled study. Cephalalgia 2004, 24:29–36.

    Article  PubMed  CAS  Google Scholar 

  15. Vernon H, McDermaid CS, Hagino C: Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache. Complement Ther Med 1999, 7:142–155.

    Article  PubMed  CAS  Google Scholar 

  16. Endres HG, Böwing G, Diener HC, et al.: Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial. J Headache Pain 2007, 8:306–314.

    Article  PubMed  Google Scholar 

  17. Linde K, Streng A, Jürgens S, et al.: Acupuncture for patients with migraine: a randomized controlled trial. JAMA 2005, 293:2118–2125.

    Article  PubMed  CAS  Google Scholar 

  18. Rains JC, Penzien DB, McCrory DC, Gray RN: Behavioral headache treatment: history, review of the empirical literature, and methodological critique. Headache 2005, 45(Suppl 2):S92–S109.

    Article  PubMed  Google Scholar 

  19. Holroyd KA, O’Donnell FJ, Stensland M, et al.: Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA 2001, 285:2208–2215.

    Article  PubMed  CAS  Google Scholar 

  20. Marhold C, Linton SJ, Melin L: A cognitive-behavioral return-to-work program: effects on pain patients with a history of long-term versus short-term sick leave. Pain 2001, 91:155–163.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  24. Verhagen AP, Damen L, Berger MY, et al.: Is any one analgesic superior for episodic tension-type headache? J Fam Pract 2006, 55:1064–1072.

    PubMed  Google Scholar 

  25. Bigal ME, Serrano D, Buse D, et al.: Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache 2008, 48:1157–1168.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  27. Lipton RB, Stewart WF, Cady R, et al.: 2000 Wolfe Award. Sumatriptan for the range of headaches in migraine sufferers: results of the Spectrum Study. Headache 2000, 40:783–791.

    Article  PubMed  CAS  Google Scholar 

  28. Cerbo R, Barbanti P, Fabbrini G, et al.: Amitriptyline is effective in chronic but not in episodic tension-type headache: pathogenetic implications. Headache 1998, 38:453–457.

    Article  PubMed  CAS  Google Scholar 

  29. Ashina S, Bendtsen L, Jensen R: Analgesic effect of amitriptyline in chronic tension-type headache is not directly related to serotonin reuptake inhibition. Pain 2004, 108:108–114.

    Article  PubMed  CAS  Google Scholar 

  30. Bendtsen L, Jensen R, Olesen J: Amitriptyline, a combined serotonin and noradrenaline re-uptake inhibitor, reduces exteroceptive suppression of temporal muscle activity in patients with chronic tension-type headache. Electroencephalogr Clin Neurophysiol 1996, 101:418–422.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  34. Nakashima K, Tumura R, Wang Y, et al.: Effects of tizanidine administration on exteroceptive suppression of the temporalis muscle in patients with chronic tension-type headache. Headache 1994, 34:455–457.

    Article  PubMed  CAS  Google Scholar 

  35. Saper JR, Lake AE III, Cantrell DT, et al.: Chronic daily headache prophylaxis with tizanidine: a double-blind, placebo-controlled, multicenter outcome study. Headache 2002, 42:470–482.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  37. Silberstein SD, Göbel H, Jensen R, et al.: Botulinum toxin type A in the prophylactic treatment of chronic tension-type headache: a multicentre, double-blind, randomized, placebo-controlled, parallel-group study. Cephalalgia 2006, 26:769–771.

    Article  Google Scholar 

  38. Naumann M, So Y, Argoff CE, et al.: Assessment: botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2008, 70:1707–1714.

    Article  PubMed  CAS  Google Scholar 

  39. Ashina M: Pathophysiology of tension-type headache: potential drug targets. CNS Neurol Disord Drug Targets 2007, 6:238–239.

    Article  PubMed  CAS  Google Scholar 

  40. Ashina M, Stallknecht B, Bendtsen L, et al.: In vivo evidence of altered skeletal muscle blood flow in chronic tension-type headache. Brain 2002, 125:320–326.

    Article  PubMed  CAS  Google Scholar 

  41. Ashina M, Stallknecht B, Bendtsen L, et al.: Tender points are not sites of ongoing inflammation: in vivo evidence in patients with chronic tension-type headache. Cephalalgia 2003, 23:109–116.

    Article  PubMed  CAS  Google Scholar 

  42. Ellrich J, Makowska A: Nerve growth factor and ATP excite different neck muscle nociceptors in anaesthetized mice. Cephalalgia 2007, 27:1226–1235.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  44. Gulbenkian S, Uddman R, Edvinsson L: Neuronal messengers in the human cerebral circulation. Peptides 2001, 22:995–1007.

    Article  PubMed  CAS  Google Scholar 

  45. Ashina M, Bendtsen L, Jensen R, et al.: Evidence for increased plasma levels of calcitonin gene-related peptide in migraine outside of attacks. Pain 2000, 86:133–138.

    Article  PubMed  CAS  Google Scholar 

  46. Edvinsson L: Neuronal signal substances as biomarkers of migraine. Headache 2006, 46:1088–1094.

    Article  PubMed  Google Scholar 

  47. Birklein F, Schmelz M: Neuropeptides, neurogenic inflammation and complex regional pain syndrome (CRPS). Neurosci Lett 2008, 437:199–202.

    Article  PubMed  CAS  Google Scholar 

  48. Zheng LF, Wang R, Xu YZ, et al.: Calcitonin gene-related peptide dynamics in rat dorsal root ganglia and spinal cord following different sciatic nerve injuries. Brain Res 2008, 1187:20–32.

    Article  PubMed  CAS  Google Scholar 

  49. Edvinsson L, Uddman R: Neurobiology in primary headaches. Brain Res Brain Res Rev 2005, 48:438–456.

    Article  PubMed  Google Scholar 

  50. Mantyh PW: Neurobiology of substance P and the NK1 receptor. J Clin Psychiatry 2002, 63(Suppl 11):6–10.

    PubMed  CAS  Google Scholar 

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Correspondence to Marcelo E. Bigal.

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Bigal, M.E., Rapoport, A.M. & Hargreaves, R. Advances in the pharmacologic treatment of tension-type headache. Current Science Inc 12, 442–446 (2008). https://doi.org/10.1007/s11916-008-0075-5

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