Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis.

PURPOSE: To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type headache (TTH). METHODS: Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized controlled trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis. RESULTS: Fifteen studies were included with a total sample of 1131 individuals. High velocity and low amplitude techniques were not superior to no treatment on reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = -0.27, moderate evidence). Soft tissue interventions were superior to no treatment on reducing pain intensity (SMD = -0.86, low evidence) and frequency of pain (SMD = -1.45, low evidence). Dry needling was superior to no treatment on reducing pain intensity (SMD = -5.16, moderate evidence) and frequency (SMD = -2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache. CONCLUSION: Manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache.Implications for rehabilitationSoft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache.High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache.Manual therapy was not effective for improving the impact of headache in patients with tension type headache.

The Effect of Body Awareness Therapy on Pain, Fatigue and Health-related Quality of Life in Female Patients with Tension-type Headaches and Migraine

ABSTRACT Objective: To examine the effect of body awareness therapy on pain, fatigue and quality of life in women with tension-type headaches (TTH) and migraine. Methods: Socio-demographic features of patients who are included in the study were recorded. Visual analogue scale was used for pain and fatigue severity scale was used for fatigue, Nottingham health profile (NHP) was used for life quality related to health. Following the first evaluation, body awareness therapy (BAT) was applied to patients for six weeks per 60 minutes in three sessions. Results: Among patients with TTH, there was statistical difference between visual analogue scale, fatigue severity scale and total NHP score before and after BAT (p < 0.05). Among patients with migraine, there was statistical difference between total NHP score before and after BAT (p < 0.05). Conclusion: Body awareness therapy is an effective method that can be used in order to increase life quality related to health among female patients with TTH and migraine.

Abordagem não-farmacológica na cefaleia do tipo tensional: efeitos da hidroterapia sobre a dor e a qualidade de vida / Non-pharmacological approach in tension-type headache: effects of hydrotherapy on pain and quality of life

Há poucos relatos na literatura de abordagens não-farmacológicas para o tratamento da cefaleia do tipo tensional (CTT), problema comum que gera impacto negativo na vida dos portadores, e nenhum sobre o protocolo de hidroterapia proposto. O objetivo do estudo foi verificar os efeitos da hidroterapia sobre a intensidade da dor e frequência das crises, bem como sua interferência na qualidade de vida dos portadores. Um protocolo de hidroterapia com 12 sessões de 60 minutos em piscina aquecida a 31º, contemplando aquecimento, alongamentos, exercícios aeróbicos e exercícios de relaxamento foi utilizado em três indivíduos com diagnóstico médico de CTT. A terapia promoveu melhora no Headache Impact Test (HIT-6), na Es- cala de sonolência de Epworth e no questionário de disfunção temporomandibular (RDC/TMD). Através do diário de dor de cabeça foi verificada redução da frequência da CTT nos três indivíduos durante a terapia e essa redução foi mantida após trinta dias do tratamento. Um indivíduo apresentou diminuição da intensidade da dor durante e após 30 dias do tratamento. O estudo sugere que a hidroterapia pode ser indicada para diminuir a frequência da CTT, bem como para melhorar a qualidade de vida dos portadores.

There are few reports in the literature of non-pharmacological approaches for the treatment of tension-type headache, common problem that generates significant negative impact on quality of life of patients, and none about therapeutic protocol proposed by this study. The aim of the study was to assess the effects of hydrotherapy on the reduction of pain intensity and frequency of crises and their interference in the quality of life of patients. A hydrotherapy protocol with 12 sessions of 60 minutes in pool heated to 31 degrees contemplating heating, stretching, aerobic and relaxation exercise was applied in three patients with clinical diagnosis of tension-type headache. The therapy promoted improvement in the Headache Impact Test (HIT-6), in the Epworth Sleepiness Scale and in the Temporomandibular Dysfunction Questionnaire (RDC / TMD). Through of a daily of headache a reduction in the frequency of tension-type headache was observed in the three individuals during therapy and this reduction was maintained after thirty days of treatment. An individual had a decrease in pain intensity during and after 30 days of treatment. The study suggests that hydrotherapy can be indicated to decrease the frequency of tension-type headache, as well as to improve the quality of life of individuals.

Cefalea tensional y homeopatía / Tension headache and homeopathy

La cefalea tensional es una patología altamente prevalente que amerita mayor investigación al respecto por su impacto a nivel personal social y económico dado la afectación a gran número de personas en edad productiva. En recientes estudios se ha dilucidado su fisiopatología, aunque aún hay controversia sobre su etiología. Se asocia a factores genéticos, centrales, reducción de umbrales de dolor y factores emocionales. Este trabajo se desarrolló dado que la homeopatía permite la traducción de los síntomas asociados a la cefalea tensional, al lenguaje homeopático, con base en ellos, realizar una repertorización que arroje medicamentos susceptibles a ser considerados al momento de formular; de tal manera que, cuando un homeópata se enfrente a pacientes con sintomatología compatible con esta patología, sin olvidar nunca la individualidad homeopática, se llegue al diagnóstico medicamentoso más acertado en pro de una rápida, duradera y segura curación para los pacientes.

Electroacupuncture analgesia is associated with increased serum brain-derived neurotrophic factor in chronic tension-type headache: a randomized, sham controlled, crossover trial.

BACKGROUND: Chronic tension-type headache (CTTH) is characterized by almost daily headaches and central sensitization, for which electroacupuncture (EA) might be effective. The central nervous system (CNS) plasticity can be tracked in serum using the brain-derived neurotrophic factor (BDNF), a neuroplasticity mediator. Thus, we tested the hypothesis that EA analgesia in CTTH is related to neuroplasticity indexed by serum BDNF. METHODS: We enrolled females aged 18-60 years with CTTH in a randomized, blinded, placebo-controlled crossover trial, comparing ten EA sessions applied for 30 minutes (2-10 Hz, intensity by tolerance) in cervical areas twice per week vs. a sham intervention. Treatment periods were separated by two washout weeks. Pain on the 10-cm visual analog scale (VAS) and serum BDNF were assessed as primary outcomes. RESULTS: Thirty-four subjects underwent randomization, and twenty-nine completed the protocol. EA was superior to sham to alleviate pain (VAS scores 2.38 ± 1.77 and 3.02 ± 2.49, respectively, P = 0.005). The VAS scores differed according to the intervention sequence, demonstrating a carryover effect (P < 0.05). Using multiple regression, serum BDNF was adjusted for the Hamilton depression rating scale (HDRS) and the VAS scores (r-squared = 0.07, standard ß coefficients = -0.2 and -0.14, respectively, P < 0.001). At the end of the first intervention period, the adjusted BDNF was higher in the EA phase (29.31 ± 3.24, 27.53 ± 2.94 ng/mL, Cohen's d = 0.55). CONCLUSION: EA analgesia is related to neuroplasticity indexed by the adjusted BDNF. EA modulation of pain and BDNF occurs according to the CNS situation at the moment of its administration, as it was related to depression and the timing of its administration.

Migraine, tension-type headache, and transformed migraine.

Migraine and tension-type headache (TTH) are highly prevalent primary headaches that remain underdiagnosed and undertreated in clinical practice. The similarities and differences between migraine and TTH may impose diagnostic challenges as well as management difficulties. In addition, the possibility of migraine chronification or transformation in daily or near-daily headache raises the potential level of interaction between pathophysiologic mechanisms of TTH and migraine. The continuum concept is a possible key to the understanding of this association. Future studies are necessary to clarify epidemiology, pathophysiology, and management of these two most prevalent headaches.

Cefalea recurrente en la consulta de neurología del Hospital Nacional de Niños: 2001-2002: [revisión] / Recurrent headache in the neurology department of Hospital Nacional de Niños: 2001-2002: [review]

Se estudiaron retrospectivamente, 78 pacientes con cefalea recurrente referidos al servicio de Neurología del HNN durante los años 2001 y 2002. 51 por ciento de los pacientes venían referidos por un pediatra, con un tiempo de espera para ser atendidos en el HNN, menor de dos meses (80 por ciento). El grupo representó el 16,5 por ciento de la consulta de pacientes nuevos. 43 varones (55.1 por ciento) y 35 mujeres (44.9 por ciento), de 2 a 13 años de edad (promedio 8), tenían menos de 1 año de evolución de cefalea (50 por ciento), de intensidad moderada (70 por ciento), pulsátil (70 por ciento) y asociada a náuses, vómitos, defectos visuales y fotofobia en 36, 30, 27 y 13 pacientes respectivamente. En 36 niños no se reportó ningún factor desencadenante pero el estrés precipitaba los síntomas en 35 casos. El 72 por ciento tenían el antecedente familiar de migraña. A 61 pacientes se les realizó una tomografía axial computarizada (TAC), que fue normal en 59, uno tenía atrofia cortical y subcortical y otro hallazgos sugestivos de neurocisticercosis. Los diagnósticos principales fueron migraña (95 por ciento) y cefalea tensional (3 por ciento), con respuesta satisfactoria (85 por ciento de los casos) a las recomendaciones, analgésicos o al tratamiento preventivo, permitiendo remitirles (75 por ciento) a sus consultas de origen. Niños con cefalea recurrente y examen neurológico normal deben recibir recomendaciones, información y seguimiento, no siendo generalmente necesario referir a Neurología, hacer exámenes paraclínicos ni hospitalizar.

[Primary cephaleas. A revision of their diagnosis and therapeutic approach]. / Cefaleas primarias. Revision de criterios diagnósticos y abordajes terapéuticos.

UNLABELLED: This review focuses on primary headaches, its diagnosis and treatment. For the IHS specialists they are: migraine, tension-type headache (TTH), cluster and others. Migraine: the second in prevalence and the first in morbility, clinical features and differences between migraine with (Ma) and without aura (Mo). EPIDEMIOLOGY: 10% prevalence and 3:1 women to men proportion. Patophysiology: primary central nociception disorder with secondary vascular involvement. TREATMENT: specific and non-specific, acute and preventive. Psychiatric disorders and migraine: there is evidence of clinical and pharmacological links, mainly between Ma and several psychiatric disorders. Migraine in childrens: important clinical and therapeutic differences from adult, importance of family approach. Migraine and hormones: the importance of estrogen drop, as trigger factor, treatment. Migraine and epilepsy: both shares neuronal hyperexcitability pattern. Migraine and stroke: vascular and ischemic factors involved. Evidence-based medicine: improves treatment's results and studies outcome evaluation. TTH: first in prevalence, still highly subdiagnosed. Main clinical presentations: episodic and chronic. EPIDEMIOLOGY: slight female preponderance. Patophysiology and trigger factors: the role of limbic nociceptive system, sedentarism stress and muscular tension. TREATMENT: pharmacological and non-pharmacological. Cluster headache: low prevalence but high daily-living activities impact, effective treatment. Other primary headaches: variability of trigger factors and role of desensitization process. CONCLUSION: we remark the complexity of headache and the of physicians' role: to relief patients suffering, throughout a precise diagnosis and treatment.

Cefaleas primarias revisión de criterios diagnósticos y abordajes terapéuticos / Primary cephaleas: a revision of its diagnosis and therapeutic approach

Esta revisión aborda las cefaleas primarias, su diagnóstico y tratamiento. Para la IHS son: migraña, cefalea tensional, cluster y otros. Migraña: La segunda en prevalencia y la de mayor morbilidad, el aura diferencia la migraña con aura (Mca) de la sin aura (Msa). Epidemiología: prevalencia 10% con una relación 3: 1 mujer-hombre. Fisiopatología: es un trastorno nociceptivo central primario, con compromiso secundario vascular. Tratamiento: específico y no específico, tanto de las crisis como preventivo. Trastornos psiquiátricos y migraña: existe evidencia de correlación clínico patológica y farmacológica mayormente entre Mca y diversas patologías psiquiátricas. Migraña en el niño: se presenta con diferencias clínicas responde a otra farmacoterapia y es de gran importancia el enfoque familiar. Migraña y hormonas: el principal factor hormonal relacionado a la migraña es la caída hormonal. Migraña y epilepsia: comparte la hiperexcitabilidad cerebral y medicación. Migraña y enfermedad cerebrovascular: factores vasculares e isquémicos comunes. Medicina basada en la evidencia: supone un importante avance en la medición de la efectividad de los tratamientos. Cefalea tensional: la más frecuente de todas las cefaleas, subdiagnosticada. Diferencias entre episódica y crónica. Epidemiología: leve preponderancia femenina. Fisiopatología y factores influyentes: destaca el rol del sistema nociceptivo, el sedentarismo, el estrés y la tensión muscular. Tratamiento: farmacológico y no farmacológico. Cefalea en racimo: de menor prevalencia pero con clínica frondosa, muy invalidante pero con tratamiento efectivo. Otras cefaleas primarias: es importante desensibilizar de los factores desencadenantes. Conclusión: rescatamos conceptos sobre la tarea del médico de aliviar el sufrimiento del paciente, a través de un diagnóstico y un tratamiento adecuados.(AU)

This review focuses on primary headaches, its diagnosis and treatment. For the IHS specialists they are: migraine, tension-type headache (TTH), cluster and others. Migraine: the second in prevalence and the first in morbility, clinical features and differences between migraine with (Ma) and without aura (Mo). Epidemiology: 10% prevalence and 3: 1 women to men proportion. Patophysiology: primary central nociception disorder with secondary vascular involvement. Treatment: specific and non-specific, acute and preventive. Psychiatric disorders and migraine: there is evidence of clinical and pharmacologicallinks, mainly between Ma and several psychiatric disorders. Migraine in childrenãs: important clinical and therapeutic differences from adult, importance of family approach. Migraine and hormones: the importance of estrogens drops, as trigger factor, treatment. Migraine and epilepsy: both shares neuronal hyperexcitability pattern. Migraine and stroke: vascular and ischemic factors involved. Evidence-based medicine: improves treatments results and studies outcome evaluation. TTH: first in prevalence, still highly sub diagnosed. Main clinical presentations: episodic and chronic. Epidemiology: slight female preponderance. Patophysiology and trigger factors: the role of limbic nociceptive system, sedentarism stress and muscular tension. Treatment: pharmacological and non-pharmacological. Cluster headache: low prevalence but high daily-living activities impact, effective treatment. Other primary headaches: variability of trigger factors and role of desensitization process. Conclusion: we remark the complexity of headache and the of physicians role: to relief patients suffering, throughout a precise diagnosis and treatment.(AU)

Cefaleas primarias revisión de criterios diagnósticos y abordajes terapéuticos / Primary cephaleas: a revision of its diagnosis and therapeutic approach

Esta revisión aborda las cefaleas primarias, su diagnóstico y tratamiento. Para la IHS son: migraña, cefalea tensional, cluster y otros. Migraña: La segunda en prevalencia y la de mayor morbilidad, el aura diferencia la migraña con aura (Mca) de la sin aura (Msa). Epidemiología: prevalencia 10% con una relación 3: 1 mujer-hombre. Fisiopatología: es un trastorno nociceptivo central primario, con compromiso secundario vascular. Tratamiento: específico y no específico, tanto de las crisis como preventivo. Trastornos psiquiátricos y migraña: existe evidencia de correlación clínico patológica y farmacológica mayormente entre Mca y diversas patologías psiquiátricas. Migraña en el niño: se presenta con diferencias clínicas responde a otra farmacoterapia y es de gran importancia el enfoque familiar. Migraña y hormonas: el principal factor hormonal relacionado a la migraña es la caída hormonal. Migraña y epilepsia: comparte la hiperexcitabilidad cerebral y medicación. Migraña y enfermedad cerebrovascular: factores vasculares e isquémicos comunes. Medicina basada en la evidencia: supone un importante avance en la medición de la efectividad de los tratamientos. Cefalea tensional: la más frecuente de todas las cefaleas, subdiagnosticada. Diferencias entre episódica y crónica. Epidemiología: leve preponderancia femenina. Fisiopatología y factores influyentes: destaca el rol del sistema nociceptivo, el sedentarismo, el estrés y la tensión muscular. Tratamiento: farmacológico y no farmacológico. Cefalea en racimo: de menor prevalencia pero con clínica frondosa, muy invalidante pero con tratamiento efectivo. Otras cefaleas primarias: es importante desensibilizar de los factores desencadenantes. Conclusión: rescatamos conceptos sobre la tarea del médico de aliviar el sufrimiento del paciente, a través de un diagnóstico y un tratamiento adecuados.

This review focuses on primary headaches, its diagnosis and treatment. For the IHS specialists they are: migraine, tension-type headache (TTH), cluster and others. Migraine: the second in prevalence and the first in morbility, clinical features and differences between migraine with (Ma) and without aura (Mo). Epidemiology: 10% prevalence and 3: 1 women to men proportion. Patophysiology: primary central nociception disorder with secondary vascular involvement. Treatment: specific and non-specific, acute and preventive. Psychiatric disorders and migraine: there is evidence of clinical and pharmacologicallinks, mainly between Ma and several psychiatric disorders. Migraine in children’s: important clinical and therapeutic differences from adult, importance of family approach. Migraine and hormones: the importance of estrogens drops, as trigger factor, treatment. Migraine and epilepsy: both shares neuronal hyperexcitability pattern. Migraine and stroke: vascular and ischemic factors involved. Evidence-based medicine: improves treatment's results and studies outcome evaluation. TTH: first in prevalence, still highly sub diagnosed. Main clinical presentations: episodic and chronic. Epidemiology: slight female preponderance. Patophysiology and trigger factors: the role of limbic nociceptive system, sedentarism stress and muscular tension. Treatment: pharmacological and non-pharmacological. Cluster headache: low prevalence but high daily-living activities impact, effective treatment. Other primary headaches: variability of trigger factors and role of desensitization process. Conclusion: we remark the complexity of headache and the of physicians' role: to relief patients suffering, throughout a precise diagnosis and treatment.

Las cefaleas crónicas / Chronic cephalea

La expresión cefalea crónica describe un síntoma, no es un diagnóstico específico. Entre el 4 y el 5 por ciento de la población general sufre de dolor de cabeza diariamente o casi diariamente. Esta cifra está indicando un severo impacto psicológico, social y económico sobre un número considerable de personas, lo cual debería implicar una atención prioritaria de parte de las autoridades y organizaciones dedicadas a la salud pública. En esta comunicación se hará referencia a los más frecuentes cuadros de cefalea crónica, como lo son la migraña crónica, la cefalea crónica del tipo tensión, la cefalea diaria persistente desde el comienzo, las cefaleas postraumáticas y la hemicránea continua, de acuerdo con los últimos consensos (International Headache Society). Un adecuado manejo de estos pacientes atendiendo las situaciones de comorbilidad como son la depresión y la ansiedad, un diagnóstico preciso y un tratamiento etiopatogénicamente dirigido serán las claves del alivio de aquellos que sufren uno de los cuadros más prevalentes de la actualidad. (AU)

Cefaléias do tipo tensional: atualizaçäo / Tension-type headaches: actualization

O termo cefaléia do tipo tensional define as cefaléias primárias anteriormente denominadas cefaléias de contração muscular, psicogênicas, psicomiogênicas, de estresse e de tensão. Essas denominações revelavam-se ambíguas e controversas, incluindo simultaneamente aspectos clínicos e propostas de fisiopatologia, não sendo universalmente aceitas e fisiopatologia, não sendo universalmente aceitas e dificultando a realização de estudos aceitos pela comunidade científica. Com a classificação internacional de cefaléias de 1988, as cefaléias do tipo tensional puderam ser melhor definidas e hoje, com a uniformidade de critérios, constituem-se no tipo mais prevalente de cefaléias primárias. Seus mecanismos são controversos e possui fisiopatologia complexa, que envolve processos centrais de disfunção antinociceptiva e periféricos de comprometimento muscular. Apresenta-se nas formas episódica e crônica e o seu tratamento divide-se em preventivo e das crises. O tratamento preventivo inclui o uso de antidepressivos tricíclicos e para algumas correntes o uso de relaxantes musculares de ação central. O tratamento das crises utiliza analgésicos e (ou) cafeína e (ou) relaxantes musculares e deve ser limitado a duas vezes por semana, uma vez que essa dor pode transformar-se em cefaléia crônica diária. Abordagens acessórias, como terapia cognitivo-comportamental, técnicas de relaxamento, biofeedback e a melhora geral das condições de vida, também são preconizadas. Há importante associação, na forma crônica, com distúrbios emocionais e do sono e o prognóstico é bom quando o paciente é corretamente tratado

Les cephalees / The headaches

Que la cephalee soit en tete de la clinique ou qu'elle ne soit qu'un symptome plus ou moins genant, c'est une des manifestations fonctionnelles les plus frequentes de l'humanite... (AU)