Tension headache medical therapy: Difference between revisions

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==Overview==
==Overview==
Episodic tension-type headaches generally respond well to over-the-counter [[analgesic]]s, such as [[paracetamol]], [[ibuprofen]] or [[aspirin]].  Simple analgesic monotherapy such as NSAIDS or aspirin are recommended (Grade 1A) for episodic TTH treatment requiring patients. Simple analgesic monotherapy is used in combination with caffeine for TTH patients who are unresponsive or have a poor response to analgesic monotherapy (Grdae 2A). Combination therapies including opioids or butalbital are not recommended as first line agents for TTH Rx (Grade 1C). Inpatient treatment for severe TTH can be treated in addition to the above mentioned treatment with chlorpromazine, metoclopramide, combination of metoclopramide and diphenhydramine and intramuscular ketorolac.
<br />
==Medical Therapy==
==Medical Therapy==
Episodic tension-type headaches generally respond well to over-the-counter [[analgesic]]s, such as [[paracetamol]], [[ibuprofen]] or [[aspirin]]. The effect of the analgesic is boosted if either caffeine (such as a cup of coffee) or a dose of the sedative antihistamine [[diphenhydramine]] (Benadryl, 25mg) is taken at the same time. However, these medications should be avoided in cases of chronic tension-type headache, due to the risk of [[Rebound headache|medication overuse headaches]].


Chronic tension-type headaches are more difficult to treat. Some therapies that are suggested for chronic tension-type headaches  include:
* Episodic tension-type headaches generally respond well to over-the-counter [[analgesic]]s, such as [[paracetamol]], [[ibuprofen]] or [[aspirin]].
* Simple analgesic monotherapy such as NSAIDS or aspirin are recommended (Grade 1A) for episodic TTH treatment requiring patients<ref name="pmid20482606">{{cite journal |vauthors=Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J |title=EFNS guideline on the treatment of tension-type headache - report of an EFNS task force |journal=Eur. J. Neurol. |volume=17 |issue=11 |pages=1318–25 |date=November 2010 |pmid=20482606 |doi=10.1111/j.1468-1331.2010.03070.x |url=}}</ref><ref name="pmid20699021">{{cite journal |vauthors=Verhagen AP, Damen L, Berger MY, Lenssinck ML, Passchier J, Kroes BW |title=[Treatment of tension type headache: paracetamol and NSAIDs work: a systematic review] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=154 |issue= |pages=A1924 |date=2010 |pmid=20699021 |doi= |url=}}</ref><ref name="pmid7555617">{{cite journal |vauthors=Lange R, Lentz R |title=Comparison ketoprofen, ibuprofen and naproxen sodium in the treatment of tension-type headache |journal=Drugs Exp Clin Res |volume=21 |issue=3 |pages=89–96 |date=1995 |pmid=7555617 |doi= |url=}}</ref>
** Ibuprofen 400mg or naproxen sodium 220 /550mg or aspirin 650-1000mg<ref name="pmid9013368">{{cite journal |vauthors=Schachtel BP, Furey SA, Thoden WR |title=Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache |journal=J Clin Pharmacol |volume=36 |issue=12 |pages=1120–5 |date=December 1996 |pmid=9013368 |doi=10.1002/j.1552-4604.1996.tb04165.x |url=}}</ref><ref name="pmid10940094">{{cite journal |vauthors=Packman B, Packman E, Doyle G, Cooper S, Ashraf E, Koronkiewicz K, Jayawardena S |title=Solubilized ibuprofen: evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache |journal=Headache |volume=40 |issue=7 |pages=561–7 |date=2000 |pmid=10940094 |doi=10.1046/j.1526-4610.2000.00087.x |url=}}</ref><ref name="pmid8665578">{{cite journal |vauthors=Dahlöf CG, Jacobs LD |title=Ketoprofen, paracetamol and placebo in the treatment of episodic tension-type headache |journal=Cephalalgia |volume=16 |issue=2 |pages=117–23 |date=April 1996 |pmid=8665578 |doi=10.1046/j.1468-2982.1996.1602117.x |url=}}</ref>
** Acetaminophen is less effective than NSAIDS/aspirin, but preferred in pregnancy
* Simple analgesic monotherapy is used in combination with caffeine for TTH patients who are unresponsive or have a poor response to analgesic monotherapy (Grdae 2A)<ref name="pmid29067618">{{cite journal |vauthors=Lipton RB, Diener HC, Robbins MS, Garas SY, Patel K |title=Caffeine in the management of patients with headache |journal=J Headache Pain |volume=18 |issue=1 |pages=107 |date=October 2017 |pmid=29067618 |pmc=5655397 |doi=10.1186/s10194-017-0806-2 |url=}}</ref><ref name="pmid21181425">{{cite journal |vauthors=Haag G, Diener HC, May A, Meyer C, Morck H, Straube A, Wessely P, Evers S |title=Self-medication of migraine and tension-type headache: summary of the evidence-based recommendations of the Deutsche Migräne und Kopfschmerzgesellschaft (DMKG), the Deutsche Gesellschaft für Neurologie (DGN), the Österreichische Kopfschmerzgesellschaft (ÖKSG) and the Schweizerische Kopfwehgesellschaft (SKG) |journal=J Headache Pain |volume=12 |issue=2 |pages=201–17 |date=April 2011 |pmid=21181425 |pmc=3075399 |doi=10.1007/s10194-010-0266-4 |url=}}</ref><ref name="pmid16162254">{{cite journal |vauthors=Diener HC, Pfaffenrath V, Pageler L, Peil H, Aicher B |title=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 |journal=Cephalalgia |volume=25 |issue=10 |pages=776–87 |date=October 2005 |pmid=16162254 |doi=10.1111/j.1468-2982.2005.00948.x |url=}}</ref>
** It is more effective than the monotherapy but associated with more side effects
** A single dose of 2 tablets of combined acetaminophen 250mg, aspirin 250mg and caffeine 65mg can be used.
* Combination therapies including opioids or butalbital are not recommended as first line agents for TTH Rx (Grade 1C).<ref name="pmid20482606">{{cite journal |vauthors=Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J |title=EFNS guideline on the treatment of tension-type headache - report of an EFNS task force |journal=Eur. J. Neurol. |volume=17 |issue=11 |pages=1318–25 |date=November 2010 |pmid=20482606 |doi=10.1111/j.1468-1331.2010.03070.x |url=}}</ref><ref name="pmid22868544">{{cite journal |vauthors=Kaniecki RG |title=Tension-type headache |journal=Continuum (Minneap Minn) |volume=18 |issue=4 |pages=823–34 |date=August 2012 |pmid=22868544 |doi=10.1212/01.CON.0000418645.32032.32 |url=}}</ref><ref name="pmid19614708">{{cite journal |vauthors=Scher AI, Lipton RB, Stewart WF, Bigal M |title=Patterns of medication use by chronic and episodic headache sufferers in the general population: results from the frequent headache epidemiology study |journal=Cephalalgia |volume=30 |issue=3 |pages=321–8 |date=March 2010 |pmid=19614708 |doi=10.1111/j.1468-2982.2009.01913.x |url=}}</ref>
** They are used when NSAIDS are contraindicated
** Also used when combination analgesics with caffeine are not effective
** They are associated with multiple adverse effects such as;
*** Dependency
*** Tolerance
*** Toxicity
*** Developing medication overuse headache
**** It can be prevented by limiting the acute therapy to 9days/month
**** And a maximum of 2 doses per treatment  day
 
=== Parenteral Therapy: ===
 
* Inpatient treatment for severe TTH can be treated in addition to the above mentioned treatment with<ref name="pmid24433525">{{cite journal |vauthors=Weinman D, Nicastro O, Akala O, Friedman BW |title=Parenteral treatment of episodic tension-type headache: a systematic review |journal=Headache |volume=54 |issue=2 |pages=260–8 |date=February 2014 |pmid=24433525 |doi=10.1111/head.12287 |url=}}</ref><ref name="pmid9484382">{{cite journal |vauthors=Harden RN, Rogers D, Fink K, Gracely RH |title=Controlled trial of ketorolac in tension-type headache |journal=Neurology |volume=50 |issue=2 |pages=507–9 |date=February 1998 |pmid=9484382 |doi=10.1212/wnl.50.2.507 |url=}}</ref>
** Chlorpromazine
** Metoclopramide
** Combination of metoclopramide and diphenhydramine
** Intramuscular ketorolac


===Pharmacological Therapy===
==== Triptans: ====
*[[Amitriptyline]]<ref>Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA. 2001 May 2;285(17):2208-15.</ref>
 
*[[Mirtazapine]]<ref>Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology. 2004 May 25;62(10):1706-11.</ref>
* Several studies have shown good response to Triptans in patients having TTH and migraine but the data is conflicting<ref name="pmid9251874">{{cite journal |vauthors=Cady RK, Gutterman D, Saiers JA, Beach ME |title=Responsiveness of non-IHS migraine and tension-type headache to sumatriptan |journal=Cephalalgia |volume=17 |issue=5 |pages=588–90 |date=August 1997 |pmid=9251874 |doi=10.1046/j.1468-2982.1997.1705588.x |url=}}</ref><ref name="pmid12011271">{{cite journal |vauthors=Lipton RB, Cady RK, Stewart WF, Wilks K, Hall C |title=Diagnostic lessons from the spectrum study |journal=Neurology |volume=58 |issue=9 Suppl 6 |pages=S27–31 |date=May 2002 |pmid=12011271 |doi=10.1212/wnl.58.9_suppl_6.s27 |url=}}</ref><ref name="pmid1335361">{{cite journal |vauthors=Brennum J, Kjeldsen M, Olesen J |title=The 5-HT1-like agonist sumatriptan has a significant effect in chronic tension-type headache |journal=Cephalalgia |volume=12 |issue=6 |pages=375–9 |date=December 1992 |pmid=1335361 |doi=10.1111/j.1468-2982.1992.00375.x |url=}}</ref>
* Asmall trial showed significant beneficial effect of small doses of sumatriptan in chronic TTH
* European guidelines for TTH do not recommend Triptans for TTH


===Non-Pharmacological Therapy===
===Non-Pharmacological Therapy===
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<br />
== References ==
== References ==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 18:22, 7 June 2020

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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

Episodic tension-type headaches generally respond well to over-the-counter analgesics, such as paracetamol, ibuprofen or aspirin. Simple analgesic monotherapy such as NSAIDS or aspirin are recommended (Grade 1A) for episodic TTH treatment requiring patients. Simple analgesic monotherapy is used in combination with caffeine for TTH patients who are unresponsive or have a poor response to analgesic monotherapy (Grdae 2A). Combination therapies including opioids or butalbital are not recommended as first line agents for TTH Rx (Grade 1C). Inpatient treatment for severe TTH can be treated in addition to the above mentioned treatment with chlorpromazine, metoclopramide, combination of metoclopramide and diphenhydramine and intramuscular ketorolac.


Medical Therapy

  • Episodic tension-type headaches generally respond well to over-the-counter analgesics, such as paracetamol, ibuprofen or aspirin.
  • Simple analgesic monotherapy such as NSAIDS or aspirin are recommended (Grade 1A) for episodic TTH treatment requiring patients[1][2][3]
    • Ibuprofen 400mg or naproxen sodium 220 /550mg or aspirin 650-1000mg[4][5][6]
    • Acetaminophen is less effective than NSAIDS/aspirin, but preferred in pregnancy
  • Simple analgesic monotherapy is used in combination with caffeine for TTH patients who are unresponsive or have a poor response to analgesic monotherapy (Grdae 2A)[7][8][9]
    • It is more effective than the monotherapy but associated with more side effects
    • A single dose of 2 tablets of combined acetaminophen 250mg, aspirin 250mg and caffeine 65mg can be used.
  • Combination therapies including opioids or butalbital are not recommended as first line agents for TTH Rx (Grade 1C).[1][10][11]
    • They are used when NSAIDS are contraindicated
    • Also used when combination analgesics with caffeine are not effective
    • They are associated with multiple adverse effects such as;
      • Dependency
      • Tolerance
      • Toxicity
      • Developing medication overuse headache
        • It can be prevented by limiting the acute therapy to 9days/month
        • And a maximum of 2 doses per treatment day

Parenteral Therapy:

  • Inpatient treatment for severe TTH can be treated in addition to the above mentioned treatment with[12][13]
    • Chlorpromazine
    • Metoclopramide
    • Combination of metoclopramide and diphenhydramine
    • Intramuscular ketorolac

Triptans:

  • Several studies have shown good response to Triptans in patients having TTH and migraine but the data is conflicting[14][15][16]
  • Asmall trial showed significant beneficial effect of small doses of sumatriptan in chronic TTH
  • European guidelines for TTH do not recommend Triptans for TTH

Non-Pharmacological Therapy


References

  1. ↑ 1.0 1.1 Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J (November 2010). "EFNS guideline on the treatment of tension-type headache - report of an EFNS task force". Eur. J. Neurol. 17 (11): 1318–25. doi:10.1111/j.1468-1331.2010.03070.x. PMID 20482606.
  2. ↑ Verhagen AP, Damen L, Berger MY, Lenssinck ML, Passchier J, Kroes BW (2010). "[Treatment of tension type headache: paracetamol and NSAIDs work: a systematic review]". Ned Tijdschr Geneeskd (in Dutch; Flemish). 154: A1924. PMID 20699021.
  3. ↑ Lange R, Lentz R (1995). "Comparison ketoprofen, ibuprofen and naproxen sodium in the treatment of tension-type headache". Drugs Exp Clin Res. 21 (3): 89–96. PMID 7555617.
  4. ↑ Schachtel BP, Furey SA, Thoden WR (December 1996). "Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache". J Clin Pharmacol. 36 (12): 1120–5. doi:10.1002/j.1552-4604.1996.tb04165.x. PMID 9013368.
  5. ↑ Packman B, Packman E, Doyle G, Cooper S, Ashraf E, Koronkiewicz K, Jayawardena S (2000). "Solubilized ibuprofen: evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache". Headache. 40 (7): 561–7. doi:10.1046/j.1526-4610.2000.00087.x. PMID 10940094.
  6. ↑ Dahlöf CG, Jacobs LD (April 1996). "Ketoprofen, paracetamol and placebo in the treatment of episodic tension-type headache". Cephalalgia. 16 (2): 117–23. doi:10.1046/j.1468-2982.1996.1602117.x. PMID 8665578.
  7. ↑ Lipton RB, Diener HC, Robbins MS, Garas SY, Patel K (October 2017). "Caffeine in the management of patients with headache". J Headache Pain. 18 (1): 107. doi:10.1186/s10194-017-0806-2. PMC 5655397. PMID 29067618.
  8. ↑ Haag G, Diener HC, May A, Meyer C, Morck H, Straube A, Wessely P, Evers S (April 2011). "Self-medication of migraine and tension-type headache: summary of the evidence-based recommendations of the Deutsche Migräne und Kopfschmerzgesellschaft (DMKG), the Deutsche Gesellschaft für Neurologie (DGN), the Österreichische Kopfschmerzgesellschaft (ÖKSG) and the Schweizerische Kopfwehgesellschaft (SKG)". J Headache Pain. 12 (2): 201–17. doi:10.1007/s10194-010-0266-4. PMC 3075399. PMID 21181425.
  9. ↑ Diener HC, Pfaffenrath V, Pageler L, Peil H, Aicher B (October 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 (10): 776–87. doi:10.1111/j.1468-2982.2005.00948.x. PMID 16162254.
  10. ↑ Kaniecki RG (August 2012). "Tension-type headache". Continuum (Minneap Minn). 18 (4): 823–34. doi:10.1212/01.CON.0000418645.32032.32. PMID 22868544.
  11. ↑ Scher AI, Lipton RB, Stewart WF, Bigal M (March 2010). "Patterns of medication use by chronic and episodic headache sufferers in the general population: results from the frequent headache epidemiology study". Cephalalgia. 30 (3): 321–8. doi:10.1111/j.1468-2982.2009.01913.x. PMID 19614708.
  12. ↑ Weinman D, Nicastro O, Akala O, Friedman BW (February 2014). "Parenteral treatment of episodic tension-type headache: a systematic review". Headache. 54 (2): 260–8. doi:10.1111/head.12287. PMID 24433525.
  13. ↑ Harden RN, Rogers D, Fink K, Gracely RH (February 1998). "Controlled trial of ketorolac in tension-type headache". Neurology. 50 (2): 507–9. doi:10.1212/wnl.50.2.507. PMID 9484382.
  14. ↑ Cady RK, Gutterman D, Saiers JA, Beach ME (August 1997). "Responsiveness of non-IHS migraine and tension-type headache to sumatriptan". Cephalalgia. 17 (5): 588–90. doi:10.1046/j.1468-2982.1997.1705588.x. PMID 9251874.
  15. ↑ Lipton RB, Cady RK, Stewart WF, Wilks K, Hall C (May 2002). "Diagnostic lessons from the spectrum study". Neurology. 58 (9 Suppl 6): S27–31. doi:10.1212/wnl.58.9_suppl_6.s27. PMID 12011271.
  16. ↑ Brennum J, Kjeldsen M, Olesen J (December 1992). "The 5-HT1-like agonist sumatriptan has a significant effect in chronic tension-type headache". Cephalalgia. 12 (6): 375–9. doi:10.1111/j.1468-2982.1992.00375.x. PMID 1335361.


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