Eficacia del tratamiento en la cefalea tensional / Efficacy of the treatment in tension-type headache

RESUMEN

Objetivos Conocer los tratamientos más eficaces para el alivio de la cefalea tensional crónica.Material y métodosSe llevó a cabo una revisión sistemática en las bases de datos de MEDLINE, PEDro, Cochrane y CINAHL, que incluyó ensayos controlados aleatorios y metaanálisis, con pacientes adultos y un número de sujetos no inferior a 15, con cefaleas tensionales y no migrañas o secundarias a otras patologías. Estudios publicados desde enero de 1998 hasta octubre de 2008, en lengua inglesa, con las palabras "effectiveness", "tension-type headache" y "treatment". En esta primera búsqueda se localizaron y revisaron 81 estudios. Posteriormente, se incluyeron en la búsqueda los términos relativos a los tratamientos "pharmacology", "botulinum toxin A", "manual therapy", "physiotherapy", "physical therapy", "psychological", "osteophathy", "chiropractic" y "cupuncture". Tras esta búsqueda, se localizaron y revisaron 80 estudios más. Finalmente, se analizaron 15 estudios que, procedentes de ambas búsquedas, reunieron los criterios de inclusión de este estudio.ResultadosLos 15 estudios analizados incluyeron tratamientos con toxina botulínica, antidepresivos, antidepresivos y terapia de control de estrés, cinesiterapia, cinesiterapia y masaje o relajación, masaje, fisioterapia manipulativa y cinesiterapia, tejido conectivo, masaje y calor, osteopatía y relajación muscular, osteopatía craneal, quiropraxia y acupuntura.ConclusionesEl tratamiento con toxina botulínica es el más utilizado entre los médicos, aunque existe una importante controversia sobre su eficacia. El tratamiento de fisioterapia más eficaz consiste en la manipulación vertebral combinado con estiramientos de la musculatura cervical y masaje. El tratamiento farmacológico más efectivo son los antidepresivos tricíclicos(AU)

ABSTRACT

Objectives To identify the most effective treatments for chronic tension-type headache relief.Material and methodsA systematic review was conducted in MEDLINE, PEDro, Cochrane and CINAHL databases. It included randomized controlled trials and meta-analysis with adult patients and a minimum of 15 subjects, with tension-type headache that were not migraines or headache secondary to other conditions. We selected studies published from January 1998 to October 2008, in English, including the terms Effectiveness, Tension-type headache, and Treatment. In this first search, 81 studies were found and reviewed. Subsequently, specific terms related to treatment—Pharmacology, Botulinum toxin A, Manual therapy, Physiotherapy, Physical therapy, Psychological, Osteopathy, Chiropractic and Acupuncture were included in our search. After this second search, 80 more studies were found and reviewed. Finally, 15 studies were found to meet the inclusion criteria and were selected to be analyzed in the present study.ResultsThe 15 studies analyzed include treatments with botulinum toxin, antidepressants, antidepressants and stress control therapy, kinesitherapy, kinesitherapy and massage or relaxation therapy, massage, kinesitherapy and manipulative physiotherapy, connective tissue therapy, massage and heat therapy, osteopathy muscular relaxation, cranial osteopathy, chiropractic and acupuncture.ConclusionsTreatment with botulinum toxin is the most frequently used among doctors, although there is significant controversy about its effectiveness. The most effective physiotherapy treatment consists of spinal manipulation, combined with cervical muscle stretching and massage. Tricyclic antidepressants are the most effective pharmacological treatment(AU)