平田幸一，竹島多賀夫： EBM に基づく慢性頭痛の治療．神経研究の進歩， 2002; 46 : 413-430 ．.
H J Featherstone
Migraine and muscle contraction headaches: a continuum.
Headache. 1985 Jun;25(4):194-8.
Abstract/Text
G C Manzoni, P Torelli
Headache screening and diagnosis.
Neurol Sci. 2004 Oct;25 Suppl 3:S255-7. doi: 10.1007/s10072-004-0300-x.
Abstract/Text
In most cases, diagnosis of the various headache subtypes is possible through the accurate collection of medical history data. However, sometimes serious problems of differential diagnosis may be encountered. Therefore, the distinction between migraine without aura and tension-type headache is not always easy, the relationship between chronic migraine and medication overuse headache is a complex one, and differentiation of chronic tension-type headache vs. new daily-persistent headache is often problematic. A clear knowledge of the distinctive clinical features of the various headache subtypes is necessary to establish a correct diagnosis in the group of unilateral headaches with short-lived attacks and in the group of headaches with nocturnal onset.
Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society.
Cephalalgia. 1988;8 Suppl 7:1-96.
Abstract/Text
Headache Classification Committee of the International headache Society: The international classification of headache disorders, 2nd edition. Cephalalgia 2004;24(Suppl 1):1-150.
Headache Classification Subcommittee of the International Headache Society
The International Classification of Headache Disorders: 2nd edition.
Cephalalgia. 2004;24 Suppl 1:9-160.
Abstract/Text
F N Kaynak Key, S Donmez, U Tuzun
Epidemiological and clinical characteristics with psychosocial aspects of tension-type headache in Turkish college students.
Cephalalgia. 2004 Aug;24(8):669-74. doi: 10.1111/j.1468-2982.2004.00736.x.
Abstract/Text
We investigated the prevalence and clinical characteristics of tension-type headache (TTH), psychosocial factors contributing to the onset and aggravation of headache and coping mechanisms of individuals in a young population in Turkey. The sample consisted of 2226 university students, aged 7 to 21 years old. A self-administered questionnaire inquiring about epidemiological and clinical features of headache was filled out by participants. TTH diagnosis was determined in accordance with the International Headache Society Criteria of 1988. The prevalence of TTH was 20.35% (25.54% for women and 14.25% for men). 43.7% of headache sufferers had one or more stressful life events before the onset of headache and stress was the most frequent aggravating factor of headache (52%). Resting (58.1%) was the most common coping style. In conclusion, TTH is not a rare condition in Turkish young people and psychosocial factors are always taken into consideration for diagnosis and treatment of TTH.
R Zivadinov, K Willheim, D Sepic-Grahovac, A Jurjevic, M Bucuk, O Brnabic-Razmilic, G Relja, M Zorzon
Migraine and tension-type headache in Croatia: a population-based survey of precipitating factors.
Cephalalgia. 2003 Jun;23(5):336-43.
Abstract/Text
The careful monitoring of the trigger factors of headache could be an important step in treatment, because their avoidance may lessen the frequency and severity of attacks. Furthermore, they may provide a clue to the aetiology of headache. The aim of the present study was to estimate the prevalence of tension-type headache (TTH) and to establish the frequency of precipitating factors in subjects with migraine and TTH in the adult population of Bakar, County of the Coast and Gorski Kotar, Croatia. Another important purpose of the study was to examine the relationship of the precipitating factors with migraine and TTH, and with migraine subtypes: migraine with aura (MA) and migraine without aura (MO). We performed a population-based survey using a 'face-to-face door-to-door' interview method. The surveyed population consisted of 5173 residents aged between 15 and 65 years. The 3794 participants (73.3%) were screened for headache history according to the International Headache Society (IHS) criteria. Headache screen-positive responders, 2475 (65.2%), were interviewed by trained medical students with a structured detailed interview focused on the precipitating factors. The following precipitating factors in lifetime migraineurs and tension-type headachers have been assessed: stress, sleep disturbances, eating habits, menstrual cycle, oral contraceptives, food items, afferent stimulation, changes in weather conditions and temperature, frequent travelling and physical activity. A total of 720 lifetime migraineurs and 1319 tension-type headachers have been identified. The most common precipitants for both migraine and TTH were stress and frequent travelling. Stress (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.17, 1.69) was associated with migraine, whereas physical activity (OR 0.72, 95% CI 0.59, 0.87) was related to TTH. Considering MA and MO, frequent travelling (OR 2.2, 95% CI 1.59, 2.99), food items (OR 2.2, 95% CI 1.35, 3.51) and changes in weather conditions and temperature (OR 1.75, 95% CI 1.27, 2.41) exhibited a significant positive association with MA. The present study demonstrated that precipitant-dependent attacks are frequent among both migraineurs and tension-type headachers. Lifetime migraineurs experienced headache attacks preceded by triggering factors more frequently than tension-type headachers. MA was more frequently associated with precipitating factors than MO. We suggest that some triggering factors may contribute to the higher occurrence of precipitant-dependent headache attacks in susceptible individuals.
B P Schachtel, S A Furey, W R Thoden
Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache.
J Clin Pharmacol. 1996 Dec;36(12):1120-5.
Abstract/Text
A single-dose, double-blind, randomized clinical trial was conducted to examine the relative analgesic effectiveness of 400 mg of ibuprofen (n = 153), 1,000 mg of acetaminophen (n = 151), and placebo (n = 151) in volunteers with muscle contraction headache. At regular intervals during a 4-hour period, participants evaluated headache pain intensity on a 100-mm visual analog scale and headache pain relief on a six-category scale. Both active agents were significantly different from placebo at all time points and in reducing pain intensity and providing relief of headache overall. Similarly, ibuprofen at 400 mg differed significantly from acetaminophen at 1,000 mg on both rating scales. Participants receiving ibuprofen at 400 mg achieved complete relief of headache faster than those receiving acetaminophen at 1,000 mg or placebo, and more participants taking ibuprofen experienced complete relief of headache than those taking placebo or acetaminophen. Both ibuprofen at 400 mg and acetaminophen at 1,000 mg are efficacious analgesic agents for muscle contraction headache, and ibuprofen at 400 mg is significantly more effective than acetaminophen at 1,000 mg for treating this condition.
Florian Kubitzek, Gabrielle Ziegler, Morris S Gold, Jiun-Min H Liu, Elisabeta Ionescu
Low-dose diclofenac potassium in the treatment of episodic tension-type headache.
Eur J Pain. 2003;7(2):155-62. doi: 10.1016/S1090-3801(02)00094-0.
Abstract/Text
BACKGROUND: Several clinical trials have demonstrated that low doses of non-steroidal anti-inflammatory drugs relieve episodic tension-type headache (ETH).
AIMS: The aims of this placebo-controlled study were to determine whether single doses of diclofenac-K 12.5 and 25mg effectively relieve ETH in adults and to compare it to ibuprofen 400mg.
METHODS: A single-dose multicentre, randomised, double-blind, double-dummy, clinical trial was conducted at 22 primary care centres in Germany. All subjects had a history of ETH according to the classification of the International Headache Society. Of 684 subjects randomised, 620 used the study drugs for an episode of tension headache occurring within one month after enrolment: diclofenac-K 12.5mg (n=160), diclofenac-K 25mg (n=156), ibuprofen 400mg (n=151) and placebo (n=153). The primary efficacy variable was total pain relief, calculated as the time-weighted sum of the pain relief assessments from baseline to the 3h evaluation time (TOTPAR-3).
RESULTS: For TOTPAR-3, all active treatments were superior to placebo; no statistically significant difference between the three active treatments could be detected. A similar pattern was also observed with regard to TOTPAR-6 (6h evaluation time), > or =50%maxTOTPAR at 3 and 6h, weighted pain intensity difference at 3 and 6h (SPID-3; SPID-6), percentage of patients with complete headache relief at 2h, end of study global evaluation and time to rescue medication. The number-needed-to-treat (NNT) at 6h was 4.5 (2.9-9.2) in the ibuprofen 400mg group, 4.0 (2.8-7.3) in the diclofenac-K 12.5mg group and 3.9 (2.7-7.1) in the diclofenac-K 25mg group. These differences were not statistically significant.
CONCLUSION: Diclofenac-K, administered as single doses of 12.5 and 25mg effectively relieves ETH and is comparable to ibuprofen 400mg.
M J Prior, K M Cooper, L G May, D L Bowen
Efficacy and safety of acetaminophen and naproxen in the treatment of tension-type headache. A randomized, double-blind, placebo-controlled trial.
Cephalalgia. 2002 Nov;22(9):740-8.
Abstract/Text
The objective of this study was to evaluate and compare the efficacy and safety of single doses of acetaminophen (paracetamol) 1000 mg and naproxen 375 mg vs. placebo over a six-hour period in the treatment of tension-type headache. The treatments were compared in a randomized, double-blind, multicentre, placebo-controlled study. Efficacy was evaluated using four standard analgesic summary endpoints (the sum of pain intensity differences from baseline, the maximum pain intensity from baseline, the sum of the pain relief scores, and the maximum pain relief score). Both acetaminophen 1000 mg and naproxen 375 mg were significantly superior to placebo (Por=0.498) for these four endpoints. For example, the mean sum of pain intensity differences from baseline was 9.14+/-0.34 for acetaminophen 1000 mg and 8.81+/-0.35 for naproxen 375 mg compared with 7.42+/-0.34 for placebo. Other efficacy endpoints (percentage of responders (pain reduced to none) at two hours, onset of meaningful relief, time to use of rescue medication and subject's overall impression of study medication) showed similar trends. A significantly larger mean pain intensity difference from baseline was observed for acetaminophen 1000 mg (1.13) than for naproxen 375 mg (0.95) (P=0.036) at one hour after treatment. There was no significant difference among the treatment groups in the incidence of adverse events (P=0.730). In summary, the results of this well-controlled, double-blind study demonstrate that over-the-counter acetaminophen 1000 mg and prescription naproxen 375 mg are effective and well tolerated in the treatment of tough (moderate-to-severe) tension-type headache.
R Cerbo, P Barbanti, G Fabbrini, M P Pascali, T Catarci
Amitriptyline is effective in chronic but not in episodic tension-type headache: pathogenetic implications.
Headache. 1998 Jun;38(6):453-7.
Abstract/Text
The tricyclic antidepressant, amitriptyline, is an effective drug for the treatment of chronic tension-type headache and for other chronic pain syndromes, but it is also effective in the prophylaxis of an episodic type of headache such as migraine. However, its efficacy in episodic tension-type headache has not yet been clarified. We compared the efficacy of amitriptyline (25 mg/day) in 82 nondepressed patients with either chronic or episodic tension-type headache in an open-label study. Amitriptyline significantly reduced (P < 0.05) frequency and duration of headache as well as analgesic consumption in chronic, but not in episodic, tension-type headache. Further placebo-controlled trials, possibly with higher doses of amitriptyline, might confirm if the different pattern of response to amitriptyline can be explained in terms of different involvement of central nociception and of peripheral myofascial factors in the chronic and in the episodic forms of tension-type headache.
