Evaluation of the Prophylactic Efficacy of Amitriptyline and Citalopram, Alone or in Combination, in Patients with Comorbidity of Depression, Migraine, and Tension-Type Headache Impact of headache disorders in Italy and the public-health and policy implications: a population-based study within the Eurolight Project Acupuncture for chronic headaches--an epidemiological study. A non-selective (amitriptyline), but not a selective (citalopram), serotonin reuptake inhibitor is effective in the prophylactic treatment of chronic tension-type headache. Selective serotonin reuptake inhibitors for migraine prophylaxis. Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial Aspirin in Episodic Tension-Type Headache: Placebo-Controlled Dose-Ranging Comparison with Paracetamol Sleep quality, arousal and pain thresholds in tension-type headache: A blinded controlled polysomnographic study Physiotherapy for Tension-Type Headache: A Controlled Study Tolerability and efficacy of a combination of paracetamol and caffeine in the treatment of tension-type headache: a randomised, double-blind, double-dummy, cross-over study versus placebo and naproxen sodium The prevalence of primary headache disorders in Russia: A countrywide survey Pilot trial of osteopathic manipulative therapy for patients with frequent episodic tension-type headache. Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial. THE EFFECT OF BODY AWARENESS THERAPY AND AEROBIC EXERCISES ON PAIN AND QUALITY OF LIFE IN THE PATIENTS WITH TENSION TYPE HEADACHE A Randomized, Double-Blind, Placebo-Controlled Study of Venlafaxine XR in Out-Patients With Tension-Type Headache Frequency of headache is related to sensitization: A population study Dextroamphetamine Pilot Crossover Trials and n of 1 Trials in Patients With Chronic Tension‐Type and Migraine Headache Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review. A randomized, placebo-controlled clinical trial of chiropractic and medical prophylactic treatment of adults with tension-type headache: results from a stopped trial. Oral almotriptan vs. oral sumatriptan in the abortive treatment of migraine: a double-blind, randomized, parallel-group, optimum-dose comparison. Migraine and Tension-Type Headache Reduction Through Pericranial Muscular Suppression: A Preliminary Report Nociceptive trigeminal inhibition--tension suppression system: a method of preventing migraine and tension headaches. Effect of manual therapy techniques on headache disability in patients with tension-type headache. Randomized controlled trial.
Antidepressants are used to treat chronic daily headache disorders such as  migraine  and chronic tension-type headache ( TTH ) , which are often associated with depression and anxiety . Here , we studied the efficacy and tolerability of amitriptyline and citalopram , given alone or in combination , in patients with ‘ triple ’ comorbidity of depression , TTH , and migraine . Eighty-eight patients were enrolled in the study and r and omly divided into two groups . The first group received amitriptyline and the second citalopram for 16 weeks . Patients were assessed at weeks 0 , 4 , 8 , and 16 . The two drugs were equally efficacious in relieving depressive symptoms , although amitriptyline was more efficacious than citalopram in reducing migraine and TTH attacks . Patients who did not respond to monotherapy ( < 30 % of improvement in the clinical scores ) were treated with a combination of the two drugs for 16 additional weeks . In these selected patients , the combined treatment produced a substantial improvement in depression , migraine and TTH without producing major side effects such as those commonly related to the ‘ serotonergic ’ syndrome . The results indicate that a combined therapy with amitriptyline and citalopram may be particularly beneficial for patients with TTH , migraine and comorbid depression that do not respond to monotherapy Background Migraine , tension-type headache ( TTH ) and medication-overuse headache ( MOH ) are disabling lifelong illnesses . The Eurolight project , a partnership activity within the Global Campaign against Headache , assessed the impact of headache disorders in ten countries in Europe using a structured question naire coupled with various sampling methods . Here we present the findings from the Italian population . Methods Question naires were distributed to a stratified sample ( N = 3500 ) of the adult ( 18–65 years ) inhabitants of Pavia province ( 1.05 % of the general population ) , r and omly selected in cooperation with the local health service . Questions included demographic and diagnostic enquries , and assessment of various aspects of impact and health-care utilisation . Results Altogether 500 question naires were returned of which 487 were adequately completed for analysis ( 58 % female , 42 % male ) . Among these , gender-adjusted lifetime prevalence of headache was 82.5 % , higher in females than in males ( 91.2 % vs 72.4 % ; p < 0.0001 ) . Gender-adjusted 1-year prevalence was 74.2 % ( females 87.7 % , males 61.1 % ; p < 0.0001 ) . The most prevalent headache type was migraine ( gender-adjusted 1-year prevalence 42.9 % ; females 54.6 % , males 32.5 % ; p < 0.0001 ) , followed by TTH ( 28.6 % ; no gender-related difference ) ; all causes of headache on ≥15 days/month were reported by 7.0 % of participants ( females 10.6 % , males 2.0 % ; p = 0.0002 ) , of whom 2.1 % , , all female ( p = 0.0064 ) concomitantly overused acute medications ( therefore probable MOH ) . Only 16.6 % of responders reporting headache had received a diagnosis from a doctor , and very few ( 2.4 % ) were taking preventative medications . Headache had negative impacts on different aspects of life : education , career and earnings , family and social life . Each person with headache had lost , on average , 2.3 days from paid work and 2.4 days from household work , and missed social occasions on 1.2 days , in the preceding 3 months . An increasing gradient for impact was observed from episodic to chronic forms of headache . Conclusions Our study reveals that in Italy , as in other countries , migraine , TTH and MOH are highly prevalent and are associated with significant personal impact . These findings have important implication s for health policy in Italy OBJECTIVE To investigate the characteristics and outcomes of patients undergoing acupuncture treatment for chronic headaches under conditions of routine care provided within the framework of statutory health insurance in Germany . Furthermore , we investigated correlations between different outcomes . PATIENTS AND METHODS Patients with migraine , episodic or chronic tension-type headache ( TTH ) , or several other forms of chronic headache ( cluster , vascular , drug-induced headache ; other specific headaches ) treated with acupuncture ( mean number of sessions 8.6 + /- 3.0 ) were included into an observational study . Detailed question naires including questions on headache days and instruments measuring disability ( Pain Disability Index ) and quality of life ( SF-36 ) were completed before treatment , after treatment , and at 6 months after inclusion . RESULTS A total of 2,022 patients ( 732 with migraine , 351 with episodic and 440 with chronic TTHs , and 499 with other diagnoses ) treated by 1,418 physicians were included in the main analysis . Sociodemographic and baseline characteristics differed considerably in the four diagnostic groups . Statistically highly significant and clinical ly relevant improvements were seen for all clinical outcome measures in all diagnostic groups . In 52.6 % of patients headache frequency decreased by at least 50 % compared to baseline . The comparison of headache frequency , pain intensity , and generic outcome measures showed that some of these outcomes correlate only weakly . CONCLUSIONS In this epidemiological study , headache patients reported clinical ly relevant improvements after receiving acupuncture . R and omized trials performed in parallel to this study confirm the relevant overall effect , however , the effect may largely be due to potent unspecific needling and placebo effects OBJECTIVES : Although the tricyclic antidepressant amitriptyline is extensively used in the prophylactic treatment of chronic tension-type headache , only few studies have investigated the efficacy of this treatment and the results are contradictory . In addition , the new selective serotonin reuptake inhibiting antidepressants , which are widely used in depression and of potential value in pain management , have never been investigated in a placebo controlled study of tension-type headache . The aim was to evaluate the efficacy of amitriptyline and of the selective serotonin reuptake inhibitor citalopram in chronic tension-type headache . METHODS : Forty non-depressed patients with chronic tension type headache were included in a 32 week , double blind , placebo controlled , three-way crossover study . RESULTS : Thirty four patients completed the trial .  Amitriptyline reduced area under the headache curve by 30 % compared with placebo ( P = 0.002 ) , whereas citalopram had no significant effect ( P = 0.68 ) . Explanatory analyses showed that amitriptyline significantly reduced the duration of headache ( P = 0.01 ) , headache frequency ( P = 0.01 ) , and intake of analgesics ( P = 0.02 ) but not headache intensity ( P = 0.12 ) . CONCLUSION : Although amitriptyline did not eliminate the headache , it provided a clinical ly important reduction of headache in the majority of otherwise treatment resistant patients . The differential effect of amitriptyline and citalopram indicates that mechanisms other than inhibition of serotonin reuptake are involved in the analgesic effect of the tricyclic antidepressants . Amitriptyline , but not citalopram , is valuable in the prophylactic treatment of chronic tension type headache The objective of this study was to assess the efficacy of sertraline in migraine prophylaxis . Other selective serotonin reuptake inhibitors have been studied for migraine prophylaxis , but this is the first report with sertraline .  Twenty-seven subjects were enrolled and baseline assessment of migraine frequency and severity were measured over a 4-week period . Subjects were then r and omized to receive placebo or sertraline in a double-blind fashion with headache frequency and severity measured over an 8-week period . Subjects completed a daily diary reporting the occurrence , severity , and degree of impairment associated with migraine . The headache index , a composite measure of migraine frequency and severity , scores did not significantly improve between assessment s at baseline ( 20.8 + /- 14.88 ) , 8 weeks ( 17.6 + /- 12.27 ) , and 12 weeks ( 16.7 + /- 6.38 ) in the treatment group ( n=6 ) ( P=0.956 ) . This finding is compared to other studies with the serotonin selective reuptake inhibitors , fluoxetine , fluvoxamine , and paroxetine . The authors believe that the selective serotonin reuptake inhibitors are not as effective as conventional migraine prophylaxis medications such as beta-blockers , tricyclic antidepressants , or divalproex sodium , but that in patients with comorbid depression who have failed conventional therapy selective serotonin reuptake inhibitors may be effective Acupuncture treatment is frequently sought for  tension-type headache ( TTH )  , but there is conflicting evidence as to its effectiveness . This r and omised , controlled , multicentre , patient- and observer-blinded trial was carried out in 122 outpatient practice s in Germany on 409 patients with TTH , defined as ≥0 headache days per month of which ≤1 included migraine symptoms . Interventions were verum acupuncture according to the practice of traditional Chinese medicine or sham acupuncture consisting of superficial needling at nonacupuncture points . Acupuncture was administered by physicians with specialist acupuncture training . Ten 30-min sessions were given over a six-week period , with additional sessions available for partial response . Response was defined as > 50 % reduction in headache days/month at six months and no use of excluded concomitant medication or other therapies . In the intent-to-treat analysis ( all 409 patients ) , 33 % of verum patients and 27 % of sham controls ( p=0.18 ) were classed as responders . Verum was superior to sham for most secondary endpoints , including headache days ( 1.8 fewer ; 95 % CI 0.6 , 3.0 ; p=0.004 ) and the International Headache Society response criterion ( 66 % vs. 55 % response , risk difference 12 % , 95 % CI : 2%-21 % ; p=0.024 ) . ) . The relative risk on the primary and secondary response criterion was very similar ( ∼0.8 ) ; the difference in statistical significance may be due to differences in event rate . TTH improves after acupuncture treatment . However , the degree to which treatment benefits depend on psychological compared to physiological effects and the degree to which any physiological effects depend on needle placement and insertion depth are unclear Most people with episodic tension-type headache ( TTH ) treat themselves with over-the-counter analgesics . In the absence of clear evidence of dose-related efficacy of the two most commonly used analgesics , aspirin ( acetylsalicylic acid ) and paracetamol ( acetaminophen ) , this study compared two doses of each with placebo . In a double-blind , double-dummy , r and omized parallel-groups comparative trial , 638 consenting subjects aged 16 - 65 years with episodic TTH ( but not migraine ) by IHS criteria were recruited from the UK general population by advertisement . They treated one episode of moderate or severe TTH with a single dose of 500 or 1000 mg aspirin , 500 or 1000 mg paracetamol or placebo . The primary objective was to compare aspirin 1000 mg with placebo , and the primary end-point was subjective pain relief ( total or worthwhile ) 2 h after treatment ( ' response ' ) . Additionally , pain intensity on a 100-mm visual analogue scale and functional impairment were monitored regularly for 4 h and at 24 h , although rescue medication was allowed after 2 h. The analysis was of the intention-to-treat population of 542 who took treatment ( all providing outcome data ) . Treatment groups were matched at baseline . Aspirin 1000 mg ( 75.7 % response rate ; P = 0.0009 ) and to a lesser extent aspirin 500 mg ( 70.3 % ; P = 0.011 ) and paracetamol 1000 mg ( 71.2 % ; P = 0.007 ) , but not paracetamol 500 mg ( 63.8 % ; P = 0.104 ) , were statistically more effective than placebo despite a high placebo-response rate ( 54.5 % ) . Outcome was not affected by headache intensity at baseline . Secondary end-points including functional recovery ( by median times of 4.0 - 13.5 h ) were consistent with these findings , although a minority of subjects recorded long- duration functional impairment ( 37 - 54 h ) . Adverse events reported by 13.4 - 18.9 % of subjects were mild or moderate , and transient . No safety concerns arose Introduction We aim ed to compare subjective and objective sleep quality in tension-type headache ( TTH ) patients and to evaluate the relationship between sleep quality and pain thresholds ( PT ) in controls and TTH patients . Methods A blinded cross-sectional study where polysomnography ( PSG ) and PT ( to pressure , heat and cold ) measurements were done in 20 patients with TTH ( eight episodic ( ETTH ) and twelve chronic ( CTTH ) TTH ) and 29 healthy controls .  Sleep diaries and question naires were applied . Results TTH patients had more anxiety ( p = 0.001 ) , insomnia ( p < 0.0005 ) , daytime tiredness ( p < 0.0005 ) and reduced subjective sleep quality ( p < 0.0005 ) compared to healthy controls . Sleep diaries revealed more long awakenings in TTH ( p = 0.01 ) but no total sleep-time differences . TTH patients had more slow-wave sleep ( p = 0.002 ) and less fast arousals ( p = 0.004 ) in their PSGs . CTTH subjects had lower pressure PT ( p = 0.048 ) and more daytime sleepiness than the controls ( p = 0.039 ) . Among TTH lower cold PT ( CPT ) correlated inversely with light sleep ( N1 ) ( r = −0.49 , p = 0.003 ) while slow arousals correlated inversely with headache-frequency ( r = −0.64 , p = 0.003 ) . Conclusions We hypothesize that TTH patients need more sleep than healthy controls and might be relatively sleep deprived . Inadequate sleep may also contribute to increased pain sensitivity and headache frequency in TTH The role of non-pharmacological therapies in the preventive treatment of tension-type headache ( TTH ) is still an object of debate . The primary aim of this study was therefore to investigate the therapeutic effect of physiotherapy in properly classified patients with TTH in a controlled trial . Fifty patients with TTH , 26 with episodic , frequent ( ETTH ) and 24 with chronic TTH ( CTTH ) fulfilling the International Headache Society classification criteria were included in the study . After a 4-week run-in period , they were r and omized to either an 8-week period of st and ardized physiotherapy ( group 1 ) or to an 8-week observation period followed by an identical course of physiotherapy ( group 2 ) ; after the physiotherapy all patients were followed for a 12-week follow-up period . We then evaluated the number of days with headache , severity and duration of the headache attacks , and drug consumption for symptomatic treatment before and after the course of physiotherapy .  Forty-eight patients completed the study . The average number of days with headache per 4-week period was reduced from 16.3 days at baseline to 12.3 days in the last 4 weeks of treatment [ from 14.5 days to 10.5 days ( P < 0.001 ) in group 1 and from 18.1 days to 14.1 days ( P < 0.001 ) in group 2 ] . Severity and duration of headache as well as drug consumption were unchanged throughout the study . Analysing the response to treatment separately in the various subgroups , we found that the number of responders was significantly higher among patients with CTTH vs. patients with ETTH ( P < 0.002 ) and in females vs. males ( P < 0.02 ) . No differences were found between patients with and without disorder of pericranial muscles . We conclude that a st and ardized physiotherapy programme has a good therapeutic effect , albeit on a restricted group of patients The main aim of this study was to confirm in an Italian population affected by tension-type headache ( TTH ) the good profile of safety and tolerability of the combination paracetamol 1,000 mg – caffeine 130 mg ( PCF ) observed in previous studies , by a comparison with naproxen sodium 550 mg ( NAP ) and placebo ( PLA ) . A secondary objective was to assess the efficacy of PCF in the acute treatment of TTH . This was a multicentre , r and omised , double-blind , double-dummy , crossover , placebo-controlled trial . Tolerability was assessed by recording adverse events by the patient in the 4-h post-dose treatment . To assess the efficacy , the sum of pain intensity differences ( SPID ) and the total pain relief ( TOTPAR ) were calculated . Comparing PCF and NAP and PCF and PLA for tolerability , the difference was nonsignificant but the result regarding noninferiority was inconclusive , whilst NAP was noninferior to PLA . As regards SPID and TOTPAR , both PCF and NAP were better than placebo ( P < 0.05 ) , but not significantly different from each other . In conclusion , PCF was well-tolerated and effective in the treatment of acute TTH Objective : To estimate the 1-year prevalences of primary headache disorders and identify their principal risk factors in the general population of Russia . Methods : A countrywide population -based r and om sample of 2725 biologically unrelated adults in 35 cities and nine rural areas were interviewed in a door-to-door survey using a previously vali date d diagnostic question naire . Results : Of the 2725 eligible adults contacted , 2025 ( 74.3 % ) responded ( females 52.6 % , mean age 39.5 ± 13.4 years ) . Of these , 1273 ( 62.9 % ) reported headache ‘ not related to flu , hangover , cold , head injury ’ occurring at least once in the previous year . The gender- and age-st and ardized 1-year prevalence of migraine was 20.8 % . Female gender ( odds ratio ( OR ) = 3.8 ; 95 % confidence interval ( CI ) 2.8–5.1 ) and obesity ( OR = 1.5 ; 1.1–2.1 ) were positively associated with this type of headache . The gender- and age-st and ardized 1-year prevalence of tension-type headache ( TTH ) was 30.8 % . TTH was more prevalent in urban than in rural areas ( OR = 1.6 ; 1.3–2.0 ) . Headache on ≥15 days/month was reported by 213 ( 10.5 % ) respondents ( gender- and age-st and ardized prevalence 10.4 % ) , and associated with low socioeconomic status ( OR = 3.4 ; 2.4–4.9 ) , obesity ( OR = 3.0 ; 2.1–4.3 ) , female gender ( OR = 2.9 ; 2.1–4.1 ) and age over 40 years ( OR = 2.6 ; 1.9–3.6 ) . The majority of these respondents ( 68.1 % ) overused acute headache medications . Conclusion : The study demonstrated a high prevalence of migraine and a very high prevalence of headache on ≥15 days/month , and revealed unmet health-care needs of people with headache in Russia CONTEXT Osteopathic manipulative therapy ( OMTh ; manipulative care provided by foreign-trained osteopaths ) may be used for managing headache pain and related disability , but there is a need for high- quality r and omized controlled trials to assess the effectiveness of this intervention . OBJECTIVE To explore the efficacy of OMTh for pain management in frequent episodic tension-type headache ( TTH ) . DESIGN Single-blind r and omized placebo-controlled pilot study . SETTING Patients were recruited from 5 primary care setting s. PATIENTS Forty-four patients who were affected by frequent episodic TTH and not taking any drugs for prophylactic management of episodic TTH were recruited . INTERVENTIONS Patients were r and omly allocated to an experimental or control group . The experimental group received corrective OMTh techniques , tailored for each patient ; the control group received assessment of the cranial rhythmic impulse ( sham therapy ) . The study included a 1-month baseline period , a 1-month treatment period , and a 3-month follow-up period . MAIN OUTCOME MEASURES The primary outcome was the change in patient-reported headache frequency , and secondary outcomes included changes in headache pain intensity ( discrete score , 1 [ lowest perceived pain ] to 5 [ worst perceived pain ] ) , over-the-counter medication use , and Headache Disability Inventory score . RESULTS Forty patients completed the study ( OMTh , n=21 ; control , n=19 ) . The OMTh group had a significant reduction in headache frequency over time that persisted 1 month ( approximate reduction , 40 % ; P<.001 ) and 3 months ( approximate reduction , 50 % ; P<.001 ) after the end of treatment . Moreover , there was an absolute difference between the 2 treatment groups at the end of the study , with a 33 % lower frequency of headache in the OMTh group ( P<.001 ) . CONCLUSION This feasibility study demonstrated the efficacy of OMTh in the management of frequent episodic TTH , compared with sham therapy in a control group . Osteopathic manipulative therapy may be preferred over other treatment modalities and may benefit patients who have adverse effects to medications or who have difficulty complying with pharmacologic regimens . This protocol may serve as a model for future studies BACKGROUND Controversy exists regarding the effectiveness of manual therapy for the relief of  tension-type headache ( TTH ) . However most studies have addressed the impact of therapy on the frequency and intensity of pain . No studies have evaluated the potentially significant effect on the patient 's quality of life . AIM To assess the quality of life of patients suffering from TTH treated for 4 weeks with different manual therapy techniques . DESIGN Factorial , r and omized , single-blinded , controlled clinical trial . SETTING Specialized center for the treatment of headache . POPULATION Seventy-six ( 62 women ) patients aged between 18 and 65 years ( age : 39.9±10.9 ) with either episodic or chronic TTH . METHODS Patients were divided into four groups : suboccipital inhibitory pressure ; suboccipital spinal manipulation ; a combination of the two treatments ; control . Quality of life was assessed using the SF-12 question naire ( considering both the overall score and the different dimensions ) at the beginning and end of treatment , and after a one month follow-up . RESULTS Compared to baseline , the suboccipital inhibition treatment group showed a significant improvement in their overall quality of life at the one month follow-up and also showed specific improvement in the dimensions related to moderate physical activities , and in their emotional role . All the treatment groups , but not the control group , showed improvements in their physical role , bodily pain , and social functioning at the one month follow-up . Post treatment and at the one month follow-up , the combined treatment group showed improved vitality and the two treatment groups that involved manipulation showed improved mental health . CONCLUSIONS All three treatments were effective at changing different dimensions of quality of life , but the combined treatment showed the most change . The results support the effectiveness of treatments applied to the suboccipital region for patients with TTH . CLINICAL REHABILITATION IMPACT Manual therapy techniques applied to the suboccipital region , for as little as four weeks , offered a positive improvement in some aspects of quality of life of patient 's suffering with TTH Background : This study is to investigate the effect of Body Awareness Therapy ( BAT ) and Aerobic Exercises on pain and quality of life in patients with Tension-Type Headache ( TTH ) . Material s and Method : Sixty individuals with TTH diagnosis who referred Neurologist were incorporated into study . The individuals were r and omly grouped into 3 as BAT ( n=20 ) , aerobic exercise ( n=20 ) and control group ( n=20 ) . Pain severity of the individuals was evaluated by Visual Analog Scale ( VAS ) and pain diary , disability with ache ; by Pain Disability Index ( PDI ) and Headache Impact Tests ( HIT ) and quality of life was evaluated by SF-36 . Subsequent to first assessment s , 3 sessions of 60 minutes per week throughout 6 weeks totally . Results : When the groups were compared at the end of the study , a significant decrease was observed in VAS , PDI and HIT values in the individuals in the BAT and aerobic exercise groups . With the individuals in group BAT and aerobic exercise all parameters of quality of life were observed to be increased significantly . Conclusion : BAT and aerobic exercise programs to be applied on TTH patients were concluded to be important in decreasing the pain , in increasing the quality of life and in reducing pain-related daily constraints of the individuals The aim of this study was to evaluate in a double-blind , r and omized , placebo-controlled study the safety and efficacy of venlafaxine extended release ( XR ) in the prophylactic treatment of out- patients with tension-type headache ( TTH ) and no current depression or anxiety disorders . Sixty neurology and headache clinic out- patients meeting the International Headache Society diagnostic criteria for TTH were treated with venlafaxine XR ( 150 mg/day , n = 34 ) or placebo ( n = 26 ) for 12 weeks . The primary efficacy variable was the decline in number of days with headache . At end-point , the venlafaxine XR group had a significantly greater decrease in the number of days with headache compared with placebo ( P = 0.05 ) . Differences with regard to secondary efficacy variables where not significant . The number needed to treat for responders ( ≥50 % reduction in days with headache ) was 3.48 . Six patients in the venlafaxine XR group interrupted therapy due to adverse events , while no patients in the placebo group did so for the same reason . The number needed to harm was 5.58 . This study provides preliminary evidence for the efficacy and safety of venlafaxine XR 150 mg/day in reducing the number of days with TTH Abstract Central sensitization is thought to play an important role in the chronification of tension‐type headache and in the maintenance and exacerbation of the migraine attack . It has , however , almost exclusively been studied in highly selected patients from headache clinics . The aim of the present study was to evaluate pain perception in primary headaches in the general population .  Stimulus – response functions for pressure versus pain , tenderness and pressure pain thresholds  were studied in a r and om sample of 523 adults from the general population . All results were controlled for the effects of age and gender . The area under the stimulus – response function was increased in chronic‐ and frequent episodic tension‐type headache compared with subjects without headache ( p < 0.001 , p < 0.001 ) and in chronic tension‐type headache compared with migraine ( p = 0.01 ) . Increasing slope ( p < 0.0001 ) and displacement towards lower pressures was found in the following order : no headache , migraine , frequent episodic tension‐type headache , chronic tension‐type headache . The displacement of the stimulus – response function was closely associated with frequency of headache . Finally , the stimulus‐response function tended to be qualitatively altered in patients with frequent headache . The findings demonstrate , for the first time in a population ‐based study , a close relation between altered pain perception and chronification of headache , which most likely can be explained by central sensitization Objective .—To examine the preventive effects of dextroamphetamine in select small groups of patients with chronic tension‐type and migraine headache BACKGROUND  Tension-type headache ( TTH ) is a disease with a great incidence on quality of life and with a significant socioeconomic impact . OBJECTIVES The aim of this review is to determine the effectiveness of physical therapy by using manual therapy ( MT ) for the relief of TTH . DATA SOURCES A review was done identifying r and omized controlled trials through search es in MEDLINE , PEDro , Cochrane and CINAHL ( January 2002 - April 2012 ) . STUDY SELECTION English- language studies , with adult patients and number of subjects not under 11 , diagnosed with episodic tension-type headache ( ETTH ) and chronic tension-type headache ( CTTH ) were included . DATA EXTRACTION Initial search was undertaken with the words Effectiveness , Tension-type headache , and Manual therapy ( 39 studies ) . In addition , a search which included terms related to treatments such as physiotherapy , physical therapy , spinal manipulation was performed ( 25 studies ) . RESULTS From the two search es 9 studies met the inclusion criteria and were analysed finding statistically significant results : 1 ) myofascial release , cervical traction , neck muscles trigger points in cervical thoracic muscles and stretching ; 2 ) Superficial heat and massage , connective tissue manipulation and vertebral Cyriax mobilization ; 3 ) cervical or thoracic spinal manipulation and cervical chin-occipital manual traction ; 4 ) massage , progressive relaxation and gentle stretching , program of active exercises of shoulder , neck and pericranial muscles ; 5 ) massage , passive rhythmic mobilization techniques , cervical , thoracic and lumbopelvic postural correction and cranio-cervical exercises ; 6 ) progressive muscular relaxation combined with joint mobilization , functional , muscle energy , and strain/counterstrain techniques , and cranial osteopathic treatment ; 7 ) massage focused on relieving myofascial trigger point activity ; 8) pressure release and muscle energy in suboccipital muscles ; 9 ) combination of mobilizations of the cervical and thoracic spine , exercises and postural correction . All studies used a combination of different techniques and none analyzed treatments separately , also all the studies have assessed aspects related to TTH beyond frequency and intensity of pain . CONCLUSIONS The findings from these studies showed evidence that physiotherapy with articulatory MT , combined with cervical muscle stretching and massage are effective for this disease in different aspects related with TTH . No evidence was found of the effectiveness of the techniques applied separately OBJECTIVES Tension-type headache ( TTH ) is the most common headache experienced by adults in Western society . Only 2 clinical trials of spinal manipulation for adult tension-type headache have been reported , neither of which was fully controlled . In 1 trial , spinal manipulation was compared to amitriptyline . There is an urgent need for well-controlled studies of chiropractic spinal manipulation for TTH . This trial was stopped prematurely due to poor recruitment . The purpose s of this report are ( 1 ) to describe the trial protocol , as it contained several novel features , ( 2 ) to report the limited data set obtained from our sample of completed subjects , and ( 3 ) to discuss the problems that were encountered in conducting this study . METHODS A r and omized clinical trial was conducted with a factorial design in which adult TTH sufferers with more than 10 headaches per month were r and omly assigned to four groups : real cervical manipulation + real amitriptyline , real cervical manipulation + placebo amitriptyline , sham cervical manipulation + real amitriptyline , and sham cervical manipulation + placebo amitriptyline . A baseline period of four weeks was followed by a treatment period of 14 weeks . The primary outcome was headache frequency obtained from a headache diary in the last 28 days of the treatment period . RESULTS Nineteen subjects completed the trial . In the unadjusted analysis , a statistically significant main effect of chiropractic treatment was obtained ( -2.2 [ -10.2 to 5.8 ] , P = .03 ) which was just below the 3-day reduction set for clinical importance . As well , a clinical ly important [ corrected ] effect of the combined therapies was obtained ( -9 [ -20.8 [ corrected ] to 2.9 ] , P = .13 ) , but this did not achieve statistical significance . In the adjusted analysis , neither the main effects of chiropractic nor amitriptyline were statistically significant or clinical ly important ; however , the effect of the combined treatments was -8.4 ( -15.8 to -1.1 ) which was statistically significant ( P = .03 ) and reached our criterion for clinical importance . CONCLUSION Although the sample size was smaller than initially required , a statistically significant and clinical ly important effect was obtained for the combined treatment group . There are considerable difficulties with recruitment of subjects in such a trial . This trial should be replicated with a larger sample BACKGROUND Almotriptan malate is a novel , selective serotonin(1B/D ) agonist , or triptan , developed for the abortive treatment of migraine . In double-blind , placebo-controlled studies , it has been shown to be effective , well tolerated , and safe . OBJECTIVE To compare the efficacy , tolerability , and safety of almotriptan with that of the " st and ard triptan , " sumatriptan succinate . The power calculation of the study was based on 24-hour headache recurrence , an efficacy measure in the abortive treatment of migraine , and on the occurrence of adverse events . SUBJECTS AND METHODS Subjects , aged between18 and 65 years , with migraine with or without aura but otherwise healthy , were r and omized to take orally either almotriptan malate , 12.5 mg , or sumatriptan succinate , 50 mg . The medications were provided in identical-looking capsules to ensure blinding and were taken for the treatment of moderate or severe headache . Efficacy was determined in terms of ( 1 ) headache relief-a decrease in pain intensity to mild or no pain ; ( 2 ) headache freedom-a decrease to no pain ; ( 3 ) use of rescue medications , allowed after 2 hours ; and ( 4 ) headache recurrence-moderate or severe pain returning within 24 hours after headache relief at 2 hours . Adverse events were collected for 96 hours after treatment and for safety evaluation , vital signs , blood tests , and electrocardiograms were performed at the screening and exit visits . RESULTS Seventy-five investigators enrolled 1255 subjects of whom 1173 were treated ( 591 with  almotriptan  and 582 with sumatriptan ) . At 2 hours , almotriptan treatment provided headache relief in 58.0 % of the subjects and sumatriptan treatment in 57.3 % ; headache freedom was provided by the medications in 17.9 % and 24.6 % , respectively ( P = .005 ) . Rescue medications were taken by 36.7 % of the subjects in the almotriptan-treated group and by 33.2 % in the sumatriptan-treated group ; headaches returned to moderate or severe intensity in 27.4 % and 24.0 % , respectively . Treatment-emergent adverse events occurred in 15.2 % of the subjects in the almotriptan-treated group and in 19.4 % in the sumatriptan-treated group ( P = .06 ) ; treatment-related adverse events occurred in 9.1 % and 15.5 % of the subjects , respectively ( P = .001 ) , including chest pain , which occurred in 0.3 % and 2.2 % , respectively ( P = .004 ) . CONCLUSIONS Almotriptan and sumatriptan are similarly effective in the abortive treatment of moderate or severe migraine headache ; they are also similarly well tolerated and safe ABSTRACT Migraine and tension-type headaches have always plagued mankind . In spite of all the research dollars spent trying to determine the etiologies of these headaches , the neurology community still has not established a known cause of migraine and tension type headaches . This paper describes a study that was conducted for the U.S. Food and Drug Administration in which the efficacy of the Nociceptive Trigeminal Inhibition Tension Suppression System  was evaluated and proved safe and efficacious in the reduction of medically diagnosed migraine and tension-type headache Dentists and physicians see countless patients suffering from various types of headaches . Various modes of therapy are used in an attempt to treat these patients . As a result of this study , it appears that a common factor to migraine and tension-type headaches may be chronic clenching . If this is the case , then dentists may be able to treat headache patients more effectively than previously suspected through the use of a dental appliance BACKGROUND Tension-type headache ( TTH ) is the most common type of primary headache however there is no clear evidence as to which specific treatment is most effective or whether combined treatment is more effective than individual treatments . AIM To assess the effectiveness of manual therapy techniques , applied to the suboccipital region , on aspects of disability in a sample of patients with tension-type headache . DESIGN R and omized Controlled Trial . SETTING Specialized centre for headache treatment . POPULATION Seventy-six ( 62 women ) patients ( age : 39.9 ± 10.9 years ) with episodic chronic TTH . METHODS Patients were r and omly divided into four treatment groups : 1 ) suboccipital soft tissue inhibition ; 2 ) occiput-atlas-axis manipulation ; 3 ) combined treatment of both techniques ; 4 ) control . Four sessions were applied over 4 weeks and disability was assessed before and after treatment using the Headache Disability Inventory ( HDI ) . Headache frequency , severity and the functional and emotional subscales of the question naire were assessed . Photophobia , phonophobia and pericranial tenderness were also monitored . RESULTS Headache frequency was significantly reduced with the manipulative and combined treatment ( P<0.05 ) , and the severity and functional subscale of the HDI changed in all three treatment groups ( P<0.05 ) . Manipulation treatment also reduced the score on the emotional subscale of the HDI ( P<0.05 ) . The combined intervention showed a greater effect at reducing the overall HDI score compared to the group that received suboccipital soft tissue inhibition and to the control group ( both P<0.05 ) . In addition , photophobia , phonophobia and pericranial tenderness only improved in the group receiving combined therapy ( P<0.05 ) . CONCLUSION When given individually , suboccipital soft tissue inhibition and occiput-atlas-axis manipulation result ed in changes in different parameters related to the disability caused by TTH . However , when the two treatments were combined , effectiveness was noted for all aspects of disability and other symptoms including photophobia , phonophobia and pericranial tenderness . CLINICAL REHABILITATION IMPACT Although individual manual therapy treatments showed a positive change in headache features , measures of photophobia , photophobia and pericranial tenderness only improved in the group that received the combined treatment suggesting that combined treatment is the most appropriate for symptomatic relief of TTH
Over 2 months of treatment , SSRIs are no more efficacious than placebo in patients with migraine .
In patients with chronic TTH , SSRIs are less efficacious than tricyclic antidepressants .
In comparison with SSRIs , the burden of adverse events in patients receiving tricyclics was greater .
BACKGROUND Headache is a common medical problem .
In view of recent discoveries about the role of serotonin in pain mechanisms , selective serotonin re-uptake inhibitors ( SSRIs ) have been evaluated for the prevention of  migraine and tension-type headaches ( TTH ) .
OBJECTIVES To evaluate the efficacy and tolerability of SSRIs for preventing migraine and TTH .