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1、EFNS GUIDELINES/CME ARTICLEEFNS guideline on the treatment of tension-type headache Report of an EFNS task forceL. Bendtsena, S. Eversb, M. Lindec, D. D. Mitsikostasd, G. Sandrinieand J. Schoenenf aDepartment of Neurology, Danish Headache Centre, Glostrup Hospital, University of Copenhagen, Copenhag
2、en, Denmark;bDepartment ofNeurology, University of Mu nster, Mu nster, Germany;cInstitute of Neuroscience and Physiology, The Sahlgrenska Academy, University ofGothenburg, Sweden and Norwegian National Headache Centre, St. Olavs Hospital, Trondheim Norway and Department of Neuroscience,Norwegian Uni
3、versity of Science and Technology, Trondheim, Norway;dDepartment of Neurology, Headache Clinic, Athens Naval Hospital,Athens, Greece;eUniversity Centre for Adaptive Disorders and Headache, IRCCS C. Mondino Institute of Neurology Foundation, Universityof Pavia, Pavia Italy; andfDepartment of Neurolog
4、y, Headache Research Unit, University of Liege, Liege, BelgiumKeywords: antidepressants, guideline, prophylaxis, tension-type headache, treatmentReceived 9 February 2010 Accepted 26 March 2010Background:Tension-type headache (TTH) is the most prevalent headache type andis causing a high degree of di
5、sability. Treatment of frequent TTH is often difficult. Objectives:To give evidence-based or expert recommendations for the different treat- mentproceduresinTTHbasedonaliteraturesearchandtheconsensusofanexpertpanel. Methods:All available medical reference systems were screened for the range ofclinic
6、al studies on TTH. The findings in these studies were evaluated according to the recommendations of the EFNS resulting in level A, B or C recommendations and good practice points. Recommendations:Non-drug management should always be considered although thescientific basis is limited. Information, re
7、assurance and identification of trigger factorsmay be rewarding. Electromyography (EMG) biofeedback has a documented effect in TTH, whilst cognitive-behavioural therapy and relaxation training most likely areeffective. Physical therapy and acupuncture may be valuable options for patients withfrequen
8、t TTH, but there is no robust scientific evidence for efficacy. Simple analgesicsand non-steroidal anti-inflammatory drugs are recommended for the treatment ofepisodic TTH. Combination analgesics containing caffeine are drugs of second choice. Triptans, muscle relaxants and opioids should not be use
9、d. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine are drugs ofsecond choice. The e
10、fficacy of the prophylactic drugs is often limited, and treatmentmay be hampered by side effects.ObjectivesThese guidelines aim to give evidence-based recom- mendations for the acute and prophylactic drug treat- ment of TTH. In addition, the guidelines aim to provide a short overview on non-drug tre
11、atment of TTH based on the best performed controlled trials, reviews andmeta-analyses, whilst the vast amount of uncontrolled reports of non-drug treatment will not be considered. A brief clinical description of the headache disorders isincluded. The definitions follow the diagnostic criteria of the
12、 International Headache Society (IHS) 1.BackgroundTension-type headache is classified into three subtypes according to headache frequency: infrequent episodic TTH (3 months (180 days per year) and fulfilling criteria BD B. Headache lasts hours or may be continuous D. Both of the following: 1. No mor
13、e than one of photophobia, phonophobia or mild nausea 2. Neither moderate or severe nausea or vomitingGuideline for treatment of tension-type headache1319? 2010 The Author(s) European Journal of Neurology ? 2010 EFNS European Journal of Neurology 17, 13181325The female:male ratio of TTH is 5:4 indic
14、ating that,unlike migraine, women are only slightly more affected than men 11,12. The average age of onset of TTH is higher than that in migraine, namely 2530 years in cross-sectional epidemiological studies 10. The preva- lence peaks between the age of 30 to 39 and decreases slightly with age. Poor
15、 self-rated health, inability to relax after work and sleeping few hours per night have been reported as risk factors for developing TTH 13. A recent review of the global prevalence and burden of headaches 11 showed that the disability of TTH as a burden of society was greater than that of migraine,
16、 which indicates that the overall cost of TTH is greater than that of migraine. Two Danish studies have shown that the number of workdays missed in the population was three times higher for TTH than for migraine 10,14, and a US study has also found that absenteeism because of TTH is considerable 15. The burden is particularly high for the minority who have substantial and complicating co-morbidities 16.Clinical aspectsTTH is characterized by a bilateral, pressing tighte
