title: Muscles and their role in episodic tension-type headache: implications for treatment.
abstract: OBJECTIVE
  Tension-type headache (TTH) imposes a heavy burden on the global population but remains incompletely understood and poorly managed.
  
  
  METHODS
  Here, we review current knowledge of peripheral factors involved in the mechanism of TTH and make recommendations for the treatment of episodic TTH based on these.
  
  
  RESULTS
  Peripheral activation or sensitization of myofascial nociceptors is most probably involved in the development of muscle pain and the acute episode of TTH. Repetitive episodes of muscle pain may sensitize the central nervous system resulting in progression of TTH to the chronic form. Thus, muscular factors may be responsible not only for the acute headache episode but also for chronification of the disorder. Simple analgesics and non-steroidal anti-inflammatory drugs are the mainstays of management of individual headache episodes. Ibuprofen 400 mg and aspirin 1000 mg are recommended as drugs of first choice based on treatment effect, safety profile and costs. Non-pharmacological therapies include electromyographic biofeedback, physiotherapy and muscle relaxation therapy. Future studies should aim to identify the triggers of peripheral nociception and how to avoid peripheral and central sensitization. There is a need for more effective, faster acting drugs for acute TTH.
  
  
  CONCLUSIONS
  Muscular factors play an important role in episodic TTH. Ibuprofen 400 mg and aspirin 1000 mg are recommended as drugs of first choice.
authors.affiliation: Danish Headache Centre, Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Bendtsen
authors.affiliation: Department of Neurology, Headache Program, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ashina
authors.affiliation: Pain Research and Nuffield Division of Anaesthetics, University of Oxford, The Churchill, Oxford, UK.
authors.forename: A
authors.initials: A
authors.lastname: Moore
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.|Division of Brain Sciences, Imperial College London, UK.
authors.forename: T J
authors.initials: TJ
authors.lastname: Steiner
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018450:Disease Progression; D006801:Humans; D018482:Muscle, Skeletal / Q000503:physiopathology*; D012064:Relaxation Therapy; D018781:Tension-Type Headache / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal