title: EFNS guideline on the treatment of tension-type headache - report of an EFNS task force.
abstract: BACKGROUND
  Tension-type headache (TTH) is the most prevalent headache type and is causing a high degree of disability. Treatment of frequent TTH is often difficult.
  
  
  OBJECTIVE
  To give evidence-based or expert recommendations for the different treatment procedures in TTH based on a literature search and the consensus of an expert panel.
  
  
  METHODS
  All available medical reference systems were screened for the range of clinical studies on TTH. The findings in these studies were evaluated according to the recommendations of the EFNS resulting in level A, B or C recommendations and good practice points.
  
  
  CONCLUSIONS
  Non-drug management should always be considered although the scientific basis is limited. Information, reassurance and identification of trigger factors may be rewarding. Electromyography (EMG) biofeedback has a documented effect in TTH, whilst cognitive-behavioural 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 non-steroidal anti-inflammatory drugs are recommended for the 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.
authors.affiliation: Department of Neurology, Danish Headache Centre, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark. larben01@glo.regionh.dk
authors.forename: L
authors.initials: L
authors.lastname: Bendtsen
authors.forename: S
authors.initials: S
authors.lastname: Evers
authors.forename: M
authors.initials: M
authors.lastname: Linde
authors.forename: D D
authors.initials: DD
authors.lastname: Mitsikostas
authors.forename: G
authors.initials: G
authors.lastname: Sandrini
authors.forename: J
authors.initials: J
authors.lastname: Schoenen
mesh_terms: D026881:Acupuncture / Q000379:methods; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D016208:Databases, Factual / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000379:methods; D017408:Guidelines as Topic; D006801:Humans; D015201:Meta-Analysis as Topic; D009407:Nerve Block / Q000379:methods; D009465:Neuromuscular Agents / Q000627:therapeutic use; D018781:Tension-Type Headache / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D014363:Tryptamines / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009465:Neuromuscular Agents; D014363:Tryptamines