Tension Headache

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A Case Study of Tension Headache and Neck Pain

A Case Study of Tension Headache and Neck Pain

CM protocols for tension headache treatment are well established and included in all major CM texts. (Wiseman, & Ellis, 1996; Maciocia, 1994; Ellis,Wiseman & Boss, 1991; Cheng, 1987; Kaptchuk, 1983; Bensky, & O’Connor, 1981; Essentials of Chinese Acupuncture 1980) Initial diagnosis determines whether the condition is arising from invasion of an Exterior Pathogen, namely: Wind-Cold, Wind-Heat or Wind-Dampness. In the absence of Exterior signs, headache is regarded as an Internal condition and will generally present as a combination of Excess and Deficiency.

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Migraine and tension headache comorbidity with hypothyroidism in Egypt

Migraine and tension headache comorbidity with hypothyroidism in Egypt

Patients with tension type headache was diagnosed ac- cording to the International Classification of Headache Disorders (ICHD)-III beta criteria [4]. All patients must have all of the following four headache characteristics: bilateral, mild-to-moderate intensity, non-pulsating headache not aggravated by routine physical activity, and their headaches must not be associated with any of nau- sea, vomiting, photophobia, or phonophobia. Chronic tension headache means that type of tension headache lasts hours and may be continuous and if headaches occur 15 or more days a month for at least 3 months [4,
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Treatments for Tension Headache and Chronic Daily Headache

Treatments for Tension Headache and Chronic Daily Headache

o No photophobia and phonophobia (or only one is present)  Organic disorder is ruled out Treatment of existing headache The goals of treatment are to reduce the severity of symptoms and the frequency of TTHAs, to decrease any related disability, and to minimize medication use to prevent progression to chronic daily headache. Non-pharmacologic self-care such as stress avoidance, stretching, warm packs or relaxation techniques can be very helpful in reducing headache pain. When TTHAs are severe or very frequent, professional interventions such as manipulation,

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Botulinum toxin injections for the treatment of frontal tension headache

Botulinum toxin injections for the treatment of frontal tension headache

Headache intensity was analyzed using a repeated measures ANOVA to account for both between and within patient variabili- ties. The average intensity for four groups was compared: (1) baseline intensity before botulinum toxin type A injection, (2) baseline intensity before placebo injection, (3) intensity after bot- ulinum toxin type A injection, and (4) intensity after placebo injection. If differences were detected between treatment groups, post hoc multiple comparison tests were performed using Tukey’s Studentized range test. All statistical analyses were performed using SAS (version 8.1, Cary, USA) statistical software. Statistical significance was declared when p values were less than 0.05.
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Migraine and Tension Headache: The latest treatment recommendations. Objectives

Migraine and Tension Headache: The latest treatment recommendations. Objectives

VA/DoD Clinical Practice Guideline for Management of Concussion/mTBI • “Headache is the single most common symptom associated with concussion/mTBI and assessment and management of headaches in individuals should parallel those for other causes of headache.”

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The effects of laser acupuncture on chronic tension headache a randomised controlled trial

The effects of laser acupuncture on chronic tension headache a randomised controlled trial

Ethical approval for the study was obtained from the Isfahan University of Medical Sciences Research Ethics Committee. Patients were selected consecutively by the neurologists of the three outpatient departments, according to the inclusion and exclusion criteria below. After giving informed consent, those who were eligible and willing to participate were assessed by an independent physician. This assessment included a detailed history and collection of baseline data and physical examination. Baseline data included age, sex, previous treatment methods, visual analogue scale (VAS) of headache intensity on a scale from zero (no pain) to 10 (most severe pain), duration of each attack (in hours), and the number of days on which headaches occurred per month since first suffering headaches.
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Headache Types. Behavioral Treatments of. Tension Headache. Migraine Headache. Mixed Headaches. TMJ Disorder. Tension Migraine.

Headache Types. Behavioral Treatments of. Tension Headache. Migraine Headache. Mixed Headaches. TMJ Disorder. Tension Migraine.

• EMG measures surface tension to train EMG measures surface tension to train muscle relaxation, reducing tension • Thermal teaches to increase hand. temperature, increasing blood flow [r]

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Onset of analgesia with ibuprofen sodium in tension-type headache: a randomized trial

Onset of analgesia with ibuprofen sodium in tension-type headache: a randomized trial

There are potential limitations of this study. The study population was very homogeneous, with 97% white/Caucasian subjects, which may limit extrapola- tion of results to the general population. However, the authors are not aware of any racial differences in the response to IBU or other NSAIDs for the treatment of tension headache. Another possible limitation is the ex- ternal validity in relation to other types of pain. How- ever, OTC IBU and other NSAIDs are efficacious in both the treatment of tension headache and other types of acute pain, and this particular formulation of IBU with sodium has also been demonstrated to be effica- cious and fast-acting in the treatment of postsurgical dental pain [17].
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Case - Tension Type Headache

Case - Tension Type Headache

The exact cause or causes of tension headache are unknown. Experts used to think that the pain of tension headache stemmed from muscle contraction in the face, neck and scalp, perhaps as a result of heightened emotions, tension or stress. But research suggests that there doesn't appear to be a significant increase in muscle tension in people diagnosed with tension headache.

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Prevalence of migraine and tension-type headache among adults in Jordan

Prevalence of migraine and tension-type headache among adults in Jordan

to the top ten list of complaints in ambulatory medical care, but our understanding of the epidemiology of headache disorders is still incomplete. Most of the recurrent head- ache cases are due to benign chronic primary headache disorders, such as tension headache and migraine. Less frequently, headache could be due to other underlying conditions such as infections, cerebral hemorrhage and brain lesions [5, 6]. The study of headache epidemiology can address a number of important questions such as var- iation in the occurrence and severity of headache in the population, and the relationship between headache and other medical disorders. In addition, these studies may provide clues to abortive treatments and preventive strat- egies for headache [7].
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Masticatory myofascial pain, and tension-type and chronic daily headache

Masticatory myofascial pain, and tension-type and chronic daily headache

The diagnosis of CDH is based on specific criteria that have been shown to accurately classify most cases (Silber- stein et al 1996). Most importantly, CDHs are defined as occurring on at least 15 days per month and may be sub- divided into two forms: primary or secondary (attribut- able to specific pathology). The most common secondary type of CDH is medication overuse headache (Chapter 13). Primary CDHs are mostly a continuation of their epi- sodic counterparts and may be short or long-lasting (>4 hours per attack) and include chronic migraine (CM; Chapter 9), chronic trigeminal autonomic cephalgias including hemicrania continua (HC; Chapter 10), CTTH and new daily persistent headache (NDPH); the latter two entities are phenotypically similar and are described in this section. The diagnosis of NDPH is reserved for patients with daily headache with strictly no history of episodic migraine or ETTH. Since most patients with daily headache have a tendency to abuse analgesics (Bigal et al 2002) that themselves potentially induce headache, the primary CDHs must occur without drug abuse. The concept of CDH is clinically and epidemiologically useful but since it represents a family of entities with dif- ferent therapeutic responses a specific diagnosis is essen- tial for successful management.
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The burden of headache is associated to pain interference, depression and headache duration in chronic tension type headache: a 1-year longitudinal study

The burden of headache is associated to pain interference, depression and headache duration in chronic tension type headache: a 1-year longitudinal study

The findings from this study show two important as- pects. First, pain interference was longitudinally associated with both emotional and physical components of burden; and second, a relevant role of emotional aspects in pa- tients with CTTH since depression and emotional compo- nent of burden indirectly mediated the effect of pain inference on the headache burden. Our results support an important association of pain interference with burden, which would agree with the conception that pain is a dimension associated to burden perception. In fact, the duration of the headache attack was also independently associated to the physical component of burden; sup- porting that not only the presence of pain, but also its duration, is relevant for burden perception. This may be related to the fact that pain interference refers to limitations on daily life activities due to the presence of pain and headache duration is related to the time with pain; therefore, this outcome reveals two different spheres of the pain spectrum.
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Pain and tension-type headache: a
review of the possible pathophysiological
mechanisms

Pain and tension-type headache: a review of the possible pathophysiological mechanisms

Another investigation tool used in patients with chron- ic pain conditions is the antinociceptive trigeminocervical reflex. In humans it was first investigated in 1986 by Sartucci et al. [53]. The exteroceptive and nociceptive inputs of the trigeminocervical reflex are probably trans- mitted through a polysynaptic route, including the spinal trigeminal nuclei and reaching the cervical motoneurones [53]. It is easily obtained by stimulation of the supraor- bital nerve and recorded by surface electrodes over the resting sternocleidomastoid muscle. Because of the bilat- eral nature of the responses and the similarities of the latency and duration of the parameters, it is comparable with R2 of the blink reflex [53, 54]. The trigeminocervi- cal reflex had a shortened latency on the painful side in patients with chronic tension-type headache and with migraine, compared to the latency on the normal side after bilateral stimulation and to healthy controls [54]. The results suggested again decreased activity of brainstem inhibitory interneurons. The reflex pattern was the same and independent of the type of headache. It may be sup- posed that some abnormalities in the endogenous pain control mechanisms are similar in both types of headache - tension-type and migraine [54]. Using another technique with recording in tonically active sternocleidomastoid muscle and stimulation of the infraorbital nerve, Nardone and Tezzon [55] confirmed the abnormality of the trigeminocervical reflex in patients with chronic tension- type headache. Thus, although the ES2 and trigeminocer- vical reflexes are probably not closely related to the pathophysiology of tension-type headache, they may be of great interest for disclosing the basic pain control mecha- nisms. That is why future studies of brainstem reflexes in patients with chronic daily headache and possibly for evaluation of drug effects are clearly worthwhile.
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Anger and emotional distress in patients with migraine and tension–type headache

Anger and emotional distress in patients with migraine and tension–type headache

recent studies suggested that patients with chronic daily headache have a significant impairment of serotonin metabolism [32, 33]. So the dysfunction of cerebral sero- tonergic system seems to be one of the key features in the mechanism of transformation of an episodic to a chronic form of headache and it may play a role in the abnormali- ties in anger experience and control observed in our patients. The results obtained by the administration of the CBA 2.0 and the BDI evidence a lack of psychopathologi- cal impairment in the migraine group compared to con- trols. On the contrary, the chronic tension-type headache and migraine associated with tension-type headache patients experienced higher levels of depressive symp- toms, state and trait anxiety, phobias (especially social refusal and departures), emotion liability, psychophysio- logical disorders and obsessive-compulsive symptoms in comparison with controls. Episodic headaches differed from controls only on trait anxiety, emotion liability and obsessive-compulsive symptoms. Our results provided evi- dence that patients with chronic tension-type headache and migraine associated with tension-type headache experi- ence more emotional distress in comparison to both migraine and tension-type headache with an episodic occurrence. However, it is important to highlight the self- report nature of the tests used and the consequent method- ological limitations of the interpretation of the data.
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Alexithymic characteristics in pediatric patients with primary headache: a comparison between migraine and tension-type headache

Alexithymic characteristics in pediatric patients with primary headache: a comparison between migraine and tension-type headache

alexithymic than controls [19 –21]. Concerning adult samples, Wise et al. [20] in comparing 100 adult patients, M or TTH sufferers, with a group of healthy controls, found higher alexithymia scores in the former. However in this study [20] no differences emerged between patients with M and patients with TTH. Yücel et al. [21] demon- strated higher levels of alexithymia in patients aged 18 –65 years suffering from episodic or chronic TTH than in healthy controls. No differences in the severity of alexithy- mia were found in cases experiencing episodic versus chronic TTH. Pini et al. [26], in line with such results found alexithymic characteristics linked to stress symp- toms in chronic TTH patients, and to a greater extent in those with medication-overuse headache. There was also preliminary evidence in this sense among preadolescent and adolescent patients with TTH, who scored higher in alexithymic features compared with controls of the same age [19].
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Alexithymic characteristics in pediatric patients with primary headache: a comparison between migraine and tension-type headache

Alexithymic characteristics in pediatric patients with primary headache: a comparison between migraine and tension-type headache

The aim of this study is to investigate alexithymic characteristics of children and adolescents with primary headache and their mothers to verify whether there is a possible relationship between headache and emotional regulation, in particular alexithymia. A wide range of psychiatric disorders, in fact, seemed to be linked to pri- mary headache and preexisting mental disorders are likely to increase the risk for the onset of headache [16]. Moreover, headaches are more common in families with a history of psychological disorders: mood and anxiety disorders run in families, just like headache symptoms, and they were shown to be more common in the parents of children with headache [17]. This points to the im- portance of assessing a broad range of psychiatric condi- tions and psychological traits, it includes alexithymia, in children and their parents, to discover important stressors and risk factors for the onset of headaches in genetically predisposed children [16–18].
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Genetics of tension-type headache

Genetics of tension-type headache

Abstract The objective of this study was to investigate the impor- tance of genetics in tension-type headache. A MEDLINE search from 1966 to December 2006 was performed for “tension-type headache and prevalence” and “tension-type headache and genet- ics”. The prevalence of tension- type headache varies from 11 to 93%, with a slight female prepon- derance. Co-occurrence of migraine increases the frequency of tension-type headache. A family study of chronic tension-type headache suggests that genetic fac- tors are important. A twin study analysing tension-type headache in migraineurs found that genetic fac- tors play a minor role in episodic tension-type headache. Another twin study analysing twin pairs without co-occurrence of migraine
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Pericranial tenderness in chronic tension-type headache: the Akershus population-based study of chronic headache

Pericranial tenderness in chronic tension-type headache: the Akershus population-based study of chronic headache

This was a cross-sectional population-based study. An age- and gender-stratified sample of 30,000 persons, aged 30–44 years, residing in eastern Akershus County was drawn from the National Personal Registry. Akershus County has both rural and urban areas and is situated in close proximity to Oslo. Data from Statistics Norway show that the sampling area was representative of the total Norwegian population regarding age, gender and marital status. Regarding employment, trade, hotel/restaurant and transport were overrepresented, while industry, oil and gas and financial services were underrepresented in the sampling area compared to the total Norwegian popula- tion. The study population received a postal questionnaire. The questions ‘How many days during the past month have you had headache?’ and ‘How many days during the past year have you had headache?’ were used to screen for chronic headache. Those with self-reported chronic head- ache (i.e. 15 days or more within the past month and/or 180 days or more within the past year) were invited to the Akershus University Hospital. Two neurological residents experienced in headache diagnostics con- ducted all interviews and the physical and neurological examinations. All headaches were classified according to the explicit diagnostic criteria of the ICHD-II and the revised criteria for medication-overuse headache [12-14]. Patients with CTTH were included into the study, while those with chronic migraine were ex- cluded. The questionnaire response rate was 71%, and the interview participation rate was 74%. Those unable to meet at the clinic were interviewed by telephone. A more detailed description of the materials and methods has been given elsewhere [9,15].
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A study of cochlear and auditory pathways in patients with tension-type headache

A study of cochlear and auditory pathways in patients with tension-type headache

The TTH group included patients recruited from the Headache Clinic of the Neurology Outpatient Depart- ment at the Peking Union Medical College Hospital. Twenty-three patients with TTH (7 females and 16 males) were involved in this study, and 46 ears were tested. Of the 23 patients, 16 had frequent episodic TTH, and 7 had chronic TTH. Patients with episodic TTH were studied during attack-free periods. The mean patient age was 34 ± 9 years (range 18–52). TTH was di- agnosed according to the criteria of the International Headache Society. The diagnosis was consistent with the International Classification of Headache Disorders-3 (beta version) codes 2.1, 2.2 and 2.3 [1]. Patients with 2.4 probable TTH were excluded. No patients had any neurotologic symptom such as tinnitus, hearing loss, dizziness or vertigo. No history of chronic otological dis- ease, ear surgery, noise exposure, ototoxicity, or any sys- temic metabolic or autoimmune disease associated with hearing loss was reported, and no history of central nervous system disease or other primary headache disor- ders, except for TTH, was reported.
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The headache-sleep study:: Sleep and pain thresholds in healthy controls and patients with migraine and tension type headache

The headache-sleep study:: Sleep and pain thresholds in healthy controls and patients with migraine and tension type headache

subgrouping also applied by other researchers (Goder et al., 2001, Della Marca et al., 2006). The division of migraineurs in different phases could have been more exact if a different type of headache diary (displaying headache per hour) had been used. However, it is our experience that this type of diary is difficult for patients to complete in a reliable way. For this reason five migraineurs with headache onset during “day zero” (the day with PT measurements and PSG mounting) were also classified as preictals. These migraineurs could be in preictal phase or early ictal phase. Furthermore, amore exact definition of a “point cero” would have been preferable, e.g. by the participants attendance at noon, when the PT measurements were performed or the time for sleep on or off set. It is possible that the procedure of PT measurements, mounting of PSG equipment and sleeping in the hospital hotel provoked an attack in some patients in a preictal phase.
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