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Treating tension-type headache -- an expert opinion.

Lars Bendtsen1, Rigmor Jensen

  • 1University of Copenhagen, Glostrup Hospital, Danish Headache Centre, Department of Neurology,Glostrup, Copenhagen, Denmark. larben01@glo.regionh.dk

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Tension-type headache (TTH) treatments include nonpharmacological options like biofeedback and cognitive-behavioral therapy, alongside medications such as amitriptyline for chronic TTH. Combining therapies can effectively manage this prevalent disorder.

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Area of Science:

  • Neurology
  • Pain Management

Background:

  • Tension-type headache (TTH) is a widespread neurological disorder.
  • TTH imposes significant personal and societal burdens.

Purpose of the Study:

  • To review current nonpharmacological and pharmacological treatments for TTH.
  • To provide guidance on effective therapeutic strategies for TTH management.

Main Methods:

  • Review of existing literature on TTH treatments.
  • Evaluation of nonpharmacological therapies including EMG biofeedback, cognitive-behavioral therapy, relaxation training, physical therapy, and acupuncture.
  • Assessment of pharmacological interventions, including acute and prophylactic medications for TTH.

Main Results:

  • Electromyographic (EMG) biofeedback, cognitive-behavioral therapy, and relaxation training show efficacy for TTH.
  • Physical therapy and acupuncture are beneficial for frequent TTH.
  • Episodic TTH management involves simple analgesics and NSAIDs; combination analgesics are second-line. Amitriptyline is the primary prophylactic treatment for chronic TTH, with mirtazapine and venlafaxine as alternatives.
  • Medication-overuse headache must be prevented by avoiding frequent analgesic use.

Conclusions:

  • Further research is needed to optimize and combine TTH treatment programs.
  • While challenging, frequent TTH can often be managed effectively through combined nonpharmacological and pharmacological approaches.