HeadWise HeadWise: Volume 4, Issue 1 | Page 19

appear to be more relevant to the processes underlying are ineffective, it is recommended to next try products episodic tension-type headache. On the other hand, that combine pain relievers with caffeine since these may “central” brain abnormalities are more likely to explain be more potent. The use of any analgesic-containing those with chronic tension-type headache. Various products should be strictly limited to an average of 2 to 3 measures of central nervous system pain processing reflect days per week at most. More frequent use could eventu- a hypersensitivity of nerve fibers in those with chronic ally contribute to toxic side effects (kidney, liver, stomach) tension-type headache. or to the potential development of a medication-overuse (“rebound”) headache disorder. Additionally, brain MRI scans in these patients have documented reduced size of several structures along the For those individuals who experience headaches more pain processing circuitry. Additional research is required frequently than 2 to 3 days per week, certain prescription to provide clarification to these findings. “preventive” medications may be used on a daily basis to decrease the frequency of episodes. Most clinicians advise forms of antidepressants or anti-seizure medications to The typical approach to the management of tension-type help stabilize tension-type headaches. One review sug- headache involves a combination of lifestyle, as well as gested that the antidepressants (amitriptyline, venlafaxine, physical and medical measures. We generally recommend and mirtazapine) had the most evidence for use in this strict regulation of sleep and meal patterns, with avoid- condition. In general, muscle relaxants do not provide ance of skipped meals and naps. Adequate hydration is significant lasting benefit and their long-term use is gen- important and we suggest 40 to 60 ounces of water intake erally discouraged. Although onabotulinum toxin (Botox) daily. Alcohol, caffeine, and artificial sweetener intake has a known effect on the muscles, studies have not should all be limited. Exercise is often beneficial and we demonstrated any significant effect in the management of recommend walking 1 to 2 miles over 30 minutes each tension-type headache. There are no surgical procedures day. deemed to be either necessary or effective. Stress management techniques may also be of great benefit. These may involve prayer, meditation, yoga, or additional activities that individual patients may Those with episodic tension-type headache often report find relaxing. Massage and cervical muscle stretches headache occurrences spread over years or even decades, are therapeutic for some individuals. Physical therapy most with frequency below one episode per month. The may be indicated for those with significant tightness in prognosis is generally favorable, with limited disability the neck muscles or for those with underlying arthritic during headache occurrences and age-related improve- changes in the cervical spine. Behavioral therapies such as ment or resolution of episodes later in life. Those less biofeedback have also been shown to be helpful in such likely to improve include patients with the chronic form situations. Acupuncture may also be beneficial of tension-type headache, those with coexisting migraine The acute treatment of a tension-type headache generally involves simple and nonspecific analgesics. Acetamin- or sleep disorders, and interestingly, those who are unmarried. HW ophen, aspirin products, and traditional nonsteroidal anti-inflammatory agents (NSAIDS) have all been shown to be helpful in the treatment of these headaches. Among these agents, the NSAIDS (ibuprofen, naproxen) may have the highest degrees of success. If simple analgesics www.headaches.org 142651_A_NHFHeadWise–June.indd 19 | National Headache Foundation 19 6/2/14 8:10 PM