Treating tension-type headache -- an expert opinion.
BACKGROUND
Tension-type headache (TTH) is a highly prevalent disorder with enormous costs for the individual and the society.


METHODS
Nonpharmacological and pharmacological treatments are reviewed. Electromyographic (EMG) biofeedback has a documented effect in TTH, while cognitive-behavioral therapy and relaxation training are most likely to be effective. Physical therapy and acupuncture may be valuable options for patients with frequent TTH. 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 the drug of first choice for the prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine are second-choice drugs.


CONCLUSIONS
There is an urgent need for more research in nonpharmacological as well as pharmacological treatment possibilities of TTH. Future studies should examine the relative efficacy of the various treatment modalities and clarify how treatment programs can be optimized and combined to best suit the individual patient. Frequent TTH may be difficult to treat, but an acceptable result can usually be obtained by a combination of nonpharmacological and pharmacological treatments.
University of Copenhagen, Glostrup Hospital, Danish Headache Centre, Department of Neurology,Glostrup, Copenhagen, Denmark. larben01@glo.regionh.dk
Lars
L
Bendtsen
Rigmor
R
Jensen
D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D004359:Drug Therapy, Combination; D005260:Female; D020773:Headache Disorders / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008297:Male; D012064:Relaxation Therapy; D018781:Tension-Type Headache / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal