Pharmacoprophylaxis of tension-type headache

Abstract

Although tension-type headache typically is not as disabling as migraine, its chronic form may significantly impair patients' functional ability. The pathogenesis of tension-type headache remains largely unknown. Compared with migraine, tension-type headache is the object of much less research. For a number of years, research on headache therapy has vastly emphasized migraine. Even cluster headache, which is far less frequent than tension-type headache, has been subject to more therapeutic trials than tension-type headache. Therefore, it is not surprising that since the advent of studies (as early as 1964) on amitriptyline, which remains a pivotal treatment choice, the number of emerging treatments for this condition remains scarce, even in 2005. This emphasizes the need for renewed interest in this field. However, alternate treatment approaches, such as botulinum toxin injections, albeit controversial, have renewed hopes lately. In addition, recent progress in the understanding of tension-type headache pathophysiology, such as the role of peripheral and central sensitization, has revived interest in the field. This is a review of available, proven, or suspected prophylactic therapies for tension-type headache.

Long-term benefits of botulinum toxin type A (BOTOX) in chronic daily headache: a five-year long experience

“…Botulinum toxin type A (BoNT-A) has been recently proposed as a new option in this approach. At present, this drug plays a possible role in the treatment of both chronic forms of TTH and migraine [4,5].…”

Diagnosis and Management of Chronic Daily Headache

“…Similar to chronic migraine, effective therapy is continued for at least 3 to 6 months prior to attempting discontinuation. 58 Table 3 summarizes prophylactic medications studied specifically in chronic tension-type headache.…”

“…50 This is the only antidepressant used in chronic tension-type headache that has demonstrated statistically significant benefit in several trials. 58 Amitriptyline has an estimated therapeutic gain of $30% based on published trials. 59,60 Nortriptyline Nortriptyline has a more favorable side effect profile than amitriptyline.…”

“…73 Combination treatment is superior to pharmacotherapy or behavioral therapy alone. 58 Combination treatment with behavioral stress management was more likely to achieve clinically significant (!50%) reductions in headache index scores (64% of participants) than antidepressant medication (38% of participants), stress management therapy (35%), or placebo (29%) in a randomized placebo-controlled trial of 203 chronic tension-type headache subjects. 62 The potential role of acupuncture in chronic tension-type headache is yet to be defined.…”

Iatrogenic Botulism in a Child With Spastic Quadriparesis

“…Botulinum toxins continue to be used off-label for a variety of other conditions, including spasticity in cerebral palsy, tics, migraines, chronic pain disorders, voiding dysfunction, and sialorrhea. [1][2][3][4][5][6][7][8] In the past few years, there has been an explosion in investigational and therapeutic applications of these neurotoxins.…”