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
Subscribers log in hereLiterature review current through: Nov 2017. | This topic last updated: Jun 16, 2016.References
- Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol 2010; 17:1318.
- Bendtsen L, Jensen R. Treating tension-type headache -- an expert opinion. Expert Opin Pharmacother 2011; 12:1099.
- Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 55:754.
- Silberstein SD, Goadsby PJ. Migraine: preventive treatment. Cephalalgia 2002; 22:491.
- Verhagen AP, Damen L, Berger MY, et al. Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review. Fam Pract 2010; 27:151.
- Jackson JL, Shimeall W, Sessums L, et al. Tricyclic antidepressants and headaches: systematic review and meta-analysis. BMJ 2010; 341:c5222.
- LANCE JW, CURRAN DA. TREATMENT OF CHRONIC TENSION HEADACHE. Lancet 1964; 1:1236.
- Diamond S, Baltes BJ. Chronic tension headache--treated with amitriptyline--a double-blind study. Headache 1971; 11:110.
- Bendtsen L, Jensen R, Olesen J. 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 1996; 61:285.
- 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.
- 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.
- Indaco A, Carrieri PB. Amitriptyline in the treatment of headache in patients with Parkinson's disease: a double-blind placebo-controlled study. Neurology 1988; 38:1720.
- Langemark M, Loldrup D, Bech P, Olesen J. Clomipramine and mianserin in the treatment of chronic tension headache. A double-blind, controlled study. Headache 1990; 30:118.
- Okasha A, Ghaleb HA, Sadek A. A double blind trial for the clinical management of psychogenic headache. Br J Psychiatry 1973; 122:181.
- Pfaffenrath V, Diener HC, Isler H, et al. Efficacy and tolerability of amitriptylinoxide in the treatment of chronic tension-type headache: a multi-centre controlled study. Cephalalgia 1994; 14:149.
- 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.
- Bendtsen L, Jensen R. Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia 2000; 20:603.
- Bendtsen L. Central sensitization in tension-type headache--possible pathophysiological mechanisms. Cephalalgia 2000; 20:486.
- Lenaerts ME. Pharmacoprophylaxis of tension-type headache. Curr Pain Headache Rep 2005; 9:442.
- Cohen GL. Protriptyline, chronic tension-type headaches, and weight loss in women. Headache 1997; 37:433.
- Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology 2004; 62:1706.
- Zissis NP, Harmoussi S, Vlaikidis N, et al. A randomized, double-blind, placebo-controlled study of venlafaxine XR in out-patients with tension-type headache. Cephalalgia 2007; 27:315.
- Banzi R, Cusi C, Randazzo C, et al. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults. Cochrane Database Syst Rev 2015; :CD011681.
- Spira PJ, Beran RG, Australian Gabapentin Chronic Daily Headache Group. Gabapentin in the prophylaxis of chronic daily headache: a randomized, placebo-controlled study. Neurology 2003; 61:1753.
- 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.
- Fogelholm R, Murros K. Tizanidine in chronic tension-type headache: a placebo controlled double-blind cross-over study. Headache 1992; 32:509.
- Murros K, Kataja M, Hedman C, et al. Modified-release formulation of tizanidine in chronic tension-type headache. Headache 2000; 40:633.
- Saper JR, Lake AE 3rd, Cantrell DT, et al. Chronic daily headache prophylaxis with tizanidine: a double-blind, placebo-controlled, multicenter outcome study. Headache 2002; 42:470.
- Warner JS. Tizanidine is not a cure for chronic daily headache. Headache 2003; 43:296; author reply 296.
- Bettucci D, Testa L, Calzoni S, et al. Combination of tizanidine and amitriptyline in the prophylaxis of chronic tension-type headache: evaluation of efficacy and impact on quality of life. J Headache Pain 2006; 7:34.
- Karadaş Ö, Inan LE, Ulaş Ü, Odabaşi Z. Efficacy of local lidocaine application on anxiety and depression and its curative effect on patients with chronic tension-type headache. Eur Neurol 2013; 70:95.
- Karadaş Ö, Gül HL, Inan LE. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache. J Headache Pain 2013; 14:44.
- Jackson JL, Kuriyama A, Hayashino Y. Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis. JAMA 2012; 307:1736.
- 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.
- Penzien DB, Rains JC, Andrasik F. Behavioral management of recurrent headache: three decades of experience and empiricism. Appl Psychophysiol Biofeedback 2002; 27:163.
- Penzien DB, Rains JC, Lipchik GL, Creer TL. Behavioral interventions for tension-type headache: overview of current therapies and recommendation for a self-management model for chronic headache. Curr Pain Headache Rep 2004; 8:489.
- Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain 1993; 53:65.
- Martin PR, MacLeod C. Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy. Clin Psychol Rev 2009; 29:483.
- McCrory, DC, Penzien, DB, Hasselblad, V, Gray, RN. Evidence Report: Behavioral and physical treatments for tension-type and cervicogenic headache, Foundation for Chiropractic Education and Research, (Product Number 2085), Des Moines, Iowa 2001.
- Nestoriuc Y, Rief W, Martin A. Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J Consult Clin Psychol 2008; 76:379.
- Verhagen AP, Damen L, Berger MY, et al. Behavioral treatments of chronic tension-type headache in adults: are they beneficial? CNS Neurosci Ther 2009; 15:183.
- Hao XA, Xue CC, Dong L, Zheng Z. Factors associated with conflicting findings on acupuncture for tension-type headache: qualitative and quantitative analyses. J Altern Complement Med 2013; 19:285.
- Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev 2016; 4:CD007587.
- Melchart D, Streng A, Hoppe A, et al. The acupuncture randomised trial (ART) for tension-type headache--details of the treatment. Acupunct Med 2005; 23:157.
- Melchart D, Streng A, Hoppe A, et al. Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ 2005; 331:376.
- Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine-systematic review and meta-analysis. Cephalalgia 2016; 36:474.
- Bronfort G, Nilsson N, Haas M, et al. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 2004; :CD001878.
- Alonso-Blanco C, de-la-Llave-Rincón AI, Fernández-de-las-Peñas C. Muscle trigger point therapy in tension-type headache. Expert Rev Neurother 2012; 12:315.
- France S, Bown J, Nowosilskyj M, et al. Evidence for the use of dry needling and physiotherapy in the management of cervicogenic or tension-type headache: a systematic review. Cephalalgia 2014; 34:994.
- Chaibi A, Russell MB. Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. J Headache Pain 2014; 15:67.
- van Ettekoven H, Lucas C. Efficacy of physiotherapy including a craniocervical training programme for tension-type headache; a randomized clinical trial. Cephalalgia 2006; 26:983.
- Mesa-Jiménez JA, Lozano-López C, Angulo-Díaz-Parreño S, et al. Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials. Cephalalgia 2015; 35:1323.
- Rolle G, Tremolizzo L, Somalvico F, et al. Pilot trial of osteopathic manipulative therapy for patients with frequent episodic tension-type headache. J Am Osteopath Assoc 2014; 114:678.
- 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