Tension-type headache in adults: Preventive treatment
- Frederick R Taylor, MD
Frederick R Taylor, MD
- Professor of Neurology
- University of Minnesota
Tension-type headache (TTH) is the most common headache in the population. Yearly prevalence rates for episodic TTH are approximately 80 percent in men and women. Due to its high prevalence in the population, TTH causes a high degree of disability. Despite its frequency, few placebo-controlled preventive therapeutic trials have been conducted in TTH. Different methods for efficacy measurement characterize these trials, making it difficult to compare results among studies . More research in the nonpharmacologic and pharmacologic treatment of TTH is urgently needed .
The available, proven, and speculative preventive therapies of TTH in adults are reviewed here. Acute treatment of TTH in adults is presented separately. (See "Tension-type headache in adults: Acute treatment".)
Other aspects of TTH are discussed elsewhere. (See "Tension-type headache in adults: Pathophysiology, clinical features, and diagnosis".)
INDICATIONS AND APPROACH TO TREATMENT
The preventive therapy of TTH ranges from drugs to nonpharmacologic therapies such as behavioral and cognitive interventions. The goals of preventive therapy in TTH are reasonably extrapolated from those devised for migraine headache . These include the following:
●Reduce attack frequency, severity, and duration
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- INDICATIONS AND APPROACH TO TREATMENT
- PHARMACOLOGIC THERAPIES
- Tricyclic antidepressants
- - Dosing and duration of therapy
- Other antidepressants
- Trigger point injections
- Botulinum toxin injections
- BEHAVIORAL THERAPIES
- Cognitive-behavioral therapy
- - Combined behavioral and tricyclic therapy
- OTHER NONPHARMACOLOGIC THERAPIES
- Physical therapies
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS