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Tension Type Headache


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EFNS guideline on the treatment of tension-type headache Report of an EFNS task forceEuropean Journal of Neurology 2010, 17: 13181325Menthored by : dr. Harry H., Sp.SPresented by : Evarista Theofika Felisia Laura Cynthia B

ObjectivesAcute and prophylactic drug treatment of TTHNon-drug treatment of TTHClinical description of the headache disordersDiagnostic criteria of the International Headache Society (IHS)

BackgroundClassification:infrequent episodic TTH ( migraine

Clinical AspectCharacteristic: a bilateral, pressing tightening pain of mild to moderate intensityshort episodes (episodic forms) or continuously (chronic form)Migraine: vomiting, severe photophobia and phonophobia~ Chronic form: one/two accompanying symptoms

DiagnosisBased on: history, normal neurological examinationHeadache diary (at least 4 weeks): triggers, medication, efficacy of treatments

DD/: TTH vs mild migraine, cervicogenic headacheImaging: suspect secondary headache, persistent neurological/psychopathological abNComorbidity: anxiety, depression

Acute Drug Treatment of TTHrefers to the treatment of individual attacks of headache in patients with episodic and chronic TTH.Episodic TTH Intensity: mild to moderate.self-manage using simple analgesics or NSAID, but frequency of the headaches efficacy Chronic TTH ~ stress, anxiety and depressionsimple analgesics ineectivethe risk of medication overuse regular intake of simple analgesics > 14 days a month or triptans or combination analgesics > 9 days a month.Other interventions non-drug treatments and prophylactic pharmacotherapy.

Acute Drug Treatment of TTHInternational Headache Society pain-free after 2 hour as the primary efficacy measure.Other efficacy measure pain intensity difference, time to meaningful relief comparison of results between studies difficult.

Simple Analgesics and NSAIDs

Naproxen 375 mg and 550 mg & metamizole 500 & 1000 mg risk of agranulocSimple Analgesics and NSAIDsOptimal DoseFew studiesAspirin 1000 mg >> 500 mg >> 250 mg.Ketoprofen 50 mg = 25 mg >> 12,5 mgParacetamol 1000 mg >> 500 mg

Simple Analgesics and NSAIDsComparison of Simple AnalgesicsNSAID >> paracetamol (5 studies), 3 studies not differentDifferent NSAID (5 studies) impossible to demonstrate superiority.Simple Analgesics and NSAIDsAdverse EventNSAID gastrointestinal side effect>> Paracetamol.Large amount of paracetamol liver injuryCombination AnalgesicsSimple analgesics, NSAID + caffeine 64-200 mg efficacy Caffeine withdrawal headache & chronic daily headache, induced MOH.+ Codein / barbiturates no comparative studies, risk of medication overuse headache (MOH).= Simple analgesics, NSAID + caffeine second choice for acute treatment of TTHTriptans, Muscle Relaxants & OpioidsTriptans not recommended in TTH, effective for mild migraines, in migraine.Muscle Relaxant not effective in episodic TTH.Opioids not recommended in TTH, risk of medication overuse headache.ConclusionsSimple analgesics & NSAID mainstay in acute therapy TTHParacetamol 1000 mg placebo with no significant diffrence.The other study : no diffrence between CBT and amitrptyline.Cognitive-behavioral therapy may be effective but there is no convincing evidence.Relaxation trainingThe goal is to help the patient to recognize and control tension s it arises in the coure of daily activitiesRelaxation training involves breathing exercises and meditation.A recent review concluded that there is conflicting evidence that relaxation is better than no treatment, waiting list or placebo

Non-invasive physical therapyIt is include : the improvement of posture, massage, spinal manupulation, oromandibular treatment, exercise progrmas, hot and cold packs, ultrasouns and electrical stimulation.

Acupunture and nerve blockA review and meta-analysis conclude that there is no evidence for efficacy ofacupunture in TTH No effect of greater occopital nerve block in patients with chronic TTH.Conclusions