A 47-Year-Old Woman With Tension-type Headaches

Welch, K. M. A.

doi:10.1001/jama.286.8.960

Cited by 7 publications

(7 citation statements)

References 34 publications

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“…Chronic Tension‐Type Headache.— Accepting that the mechanisms of chronic tension‐type headache (CTTH) remain to be definitively established, could one still conclude that this is the one primary headache disorder that plausibly might prove susceptible to BoNT‐A therapy; the drug can paralyze muscle, 2 and perhaps ameliorate peripheral pain effects 3 . Factors that would seem to favor the initiation of trials of BoNT‐A for CTTH have been reviewed and include the presence of muscle tenderness, increased frontalis muscle activity on electromyography (EMG), correlations between EMG activity and tenderness, associations between headache provocation and preexisting tenderness, and low pain thresholds for pressure and mechanical muscle displacement 4 . Even so, results from such trials have been mixed 5–9 .…”

Section: Evidence‐based Reviews Of the Datamentioning

confidence: 99%

“…3 Factors that would seem to favor the initiation of trials of BoNT-A for CTTH have been reviewed and include the presence of muscle tenderness, increased frontalis muscle activity on electromyography (EMG), correlations between EMG activity and tenderness, associations between headache provocation and preexisting tenderness, and low pain thresholds for pressure and mechanical muscle displacement. 4 Even so, results from such trials have been mixed. [5][6][7][8][9] An evidencebased categorization of the BoNT-A CTTH trials is 6 Relja and Klepac 9 II.…”

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confidence: 99%

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Botulinum Toxin Type A for the Treatment of Headache: Con

Welch

2004

Headache

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Section: Evidence‐based Reviews Of the Datamentioning

confidence: 99%

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confidence: 99%

Botulinum Toxin Type A for the Treatment of Headache: Con

Welch

2004

Headache

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“…As a model of more persistent head pain than migraine, CTTH is possibly a more suitable headache variant to study the putative antinociceptive action of BT‐A. Presence of muscle tenderness, increased frontalis muscle activity on electromyography, correlations between electromyographic activity and tenderness, association between headache provocation and preexisting pericranial tenderness, and low pain thresholds for pressure and mechanical muscle displacement suggest that BT‐A could be a particularly useful agent to manage CTTH [33,47]. Evidence from three level I B trials in CTTH [48–50] does not support the use of BT‐A for its management [33,42], the negative outcome being consistent with the lack of a definitive analgesic action in normal human subjects [19–21].…”

Section: Clinical Studies Of Bt‐a In Migrainementioning

confidence: 99%

Botulinum Toxin—A Treatment for Migraine? A Systematic Review

2006

Pain Med

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Scalp injection of botulinum toxin type A (BT-A) into the superficial musculature has evoked interest in the management of migraine headache. In clinical trials, prevention of migraine attacks for 3 months or more has been seen in some patients following BT-A scalp injections. In the majority of pain syndromes where BT-A is effective, inhibition of muscle spasms appears to be an important component of its activity. A direct or independent and prolonged analgesic action unrelated to skeletal muscle relaxation is believed to underlie the prophylactic efficacy of BT-A in migraine; peripheral and central modulation of pain impulses by BT-A has also been proposed. A direct peripheral antinociceptive effect was not seen in three controlled studies of BT-A in normal human volunteers. Experimental evidence for BT-A-induced analgesia in rats is suggestive but dose-dependent and lasts only 2 weeks. In migraine patients, a consistent or dose-dependent response to BT-A treatment has not been seen. Peak responses to BT-A in migraine patients are seen at 8-12 weeks, whereas BT-A-affected nerve endings in mice fully recover function between 63 and 91 days; the difference in species limits the interpretation of this dissonance. As BT-A does not normally cross the intact blood-brain barrier, meningeal nociceptors appear unlikely to be influenced by scalp injections of BT-A; the possibility of antidromic transfer of BT-A in the trigeminovascular system should be considered. The extended period for which migraine prophylaxis might be required, the antigenic and headache-provoking potential of BT-A, the inability of BT-A to affect central neuronal processes significantly, including the aura of migraine, the possible placebo effect of needling, and purely subjective outcome measures in headache studies are additional concerns in evaluating this treatment strategy. The clinical utility of BT-A has not been compared against established migraine prophylactic agents. The efficacy of BT-A in preventing migraine headache attacks remains controversial and the underlying scientific rationale is debatable.

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“…Uma breve revisão da literatura sobre o tema revelou a tendência em buscar fatores biológicos relacionados com a etiologia do problema, sem referências esclarecedoras sobre os aspectos culturais, contextuais e comportamentais que também funcionam como determinantes para cefaléias do tipo tensional. Estudos recentes, no entanto, permitem apontar que, em função da complexidade dos fatores envolvidos na etiologia da cefaléia de tensão, o modelo estritamente biológico, tal como em outras patologias, tem sido insuficiente para proporcionar os recursos terapêuticos eficientes às queixas psicossociais que acompanham esses pacientes (Adams, 1985;Rollnik, Karst, Fink, & Dengler, 2001;Spinhoven, Jochems, Linssen, & Bogaards, 1991;Waldie, & Poulton, 2002;Welch, 2001, Zannon, 1991. Considerando, portanto, que o fenômeno da dor é multidimensionado, o presente artigo procurou compreendê-lo de forma idiográfica e sistêmica a partir da formulação de um caso clínico.…”

Section: Introductionunclassified

Relevância Clínica Dos Aspectos Comportamentais Nas Cefaléias Do Tipo Tensional: Estudo Exploratório

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2017

PsicolArgum

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As cefaléias constituem queixas freqüentes em unidades básicas de saúde e unidades de emergência médica. Entre os diversos diagnósticos possíveis, a cefaléia do tipo tensional é ainda uma dor mal compreendida e, freqüentemente, relacionada a fatores de estresse. O estudo de sua fisiopatologia vem privilegiando determinantes biológicos com menor atenção aos aspectos contextuais e comportamentais que compõem o problema. O presente trabalho considerou a experiência dolorosa multidimensionada e procurou uma compreensão idiográfica e sistêmica do assunto através da análise de um caso. O estudo foi baseado em avaliações seqüenciais, ao longo de quatro meses, de uma paciente com queixa de cefaléia primária diária. A análise do paciente demonstrou que a etiologia da cefaléia estava relacionada também a outros fatores como: exposição a contextos potencialmente estressantes, repertório pessoal e familiar de enfrentamento à dor inadequado, presença de reforço ambiental à dor, uso abusivo de analgésicos e desgastes no relacionamento com profissionais da saúde. Concluiu-se a favor de maior sofisticação dos modelos em saúde para a inclusão de fatores sociais, culturais e comportamentais na avaliação da experiência dolorosa, permitindo planos de tratamento individualizados e atentos às demandas globais de seus pacientes

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A 47-Year-Old Woman With Tension-type Headaches

Cited by 7 publications

References 34 publications

Botulinum Toxin Type A for the Treatment of Headache: Con

Botulinum Toxin Type A for the Treatment of Headache: Con

Botulinum Toxin—A Treatment for Migraine? A Systematic Review

Relevância Clínica Dos Aspectos Comportamentais Nas Cefaléias Do Tipo Tensional: Estudo Exploratório

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