Management of Tension-Type Headache
Management of the acute episode in patients with infrequent tension-type headache (TTH) is often straightforward, but in patients with frequent TTH management is often difficult. Establishment of an accurate diagnosis is important before initiation of any treatment. Nondrug management should always be considered although the scientific basis is limited. Information, reassurance, and identification of trigger factors may be rewarding. EMG biofeedback has a documented effect in TTH, while cognitive-behavioral therapy and relaxation training most likely are effective. Physical therapy and acupuncture may be valuable options for patients with frequent TTH, but there is no robust scientific evidence for efficacy.
Simple analgesics and nonsteroidal anti-inflammatory drugs are recommended for treatment of episodic TTH. Combination analgesics containing caffeine are drugs of second choice. Triptans, muscle relaxants, and opioids should not be used. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine are drugs of second choice. The efficacy of the prophylactic drugs is often limited and treatment may be hampered by side effects.
KeywordsRelaxation Training Simple Analgesic Tetracyclic Antidepressant Combination Analgesic Great Occipital Nerve Block
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