Tension headache medical therapy: Difference between revisions

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Revision as of 04:49, 4 June 2020

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
- Ibuprofen 400mg or naproxen sodium 220 /550mg or aspirin 650-1000mg
- 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)
- 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).
- 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
- 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
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

Acupuncture
Biofeedback
Cranial chiropractic
Exercise such as swimming two to three times a week
Heat pillow
Massage
Relaxation techniques like:
- Jacobson's Progressive Muscle Relaxation
- Autogenic training

References

Template:WikiDoc Sources

@@ Line 4: / Line 4: @@
 ==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==
-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
+** Ibuprofen 400mg or naproxen sodium 220 /550mg or aspirin 650-1000mg
+** 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)
+** 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).
+** 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
+** Chlorpromazine
+** Metoclopramide
+** Combination of metoclopramide and diphenhydramine
+** Intramuscular ketorolac
+==== Triptans: ====
-===Pharmacological Therapy===
+* Several studies have shown good response to Triptans in patients having TTH and migraine but the data is conflicting
-*[[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>
+* Asmall trial showed significant beneficial effect of small doses of sumatriptan in chronic TTH
-*[[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>
+* European guidelines for TTH do not recommend Triptans for TTH
 ===Non-Pharmacological Therapy===