THE TREATMENT OF TENSION-TYPE HEADACHE - GUIDELINES OF THE GERMAN-MIGRAINE-AND-HEADACHE-SOCIETY

Tension-type headache is characterised by a dull-pressing and bilatera l headache in which the autonomic symptoms typical of migraine are abs ent or only weakly present. The IHS-Classification differentiates betw een an episodic (< 180 days/year) and a chronic (> 180 days/year) tens ion-type headache. The prevalence of chronic tension-type headache is 3%, There are no particular pathological findings characteristic for t his disease. The differential diagnosis of tension-type headache inclu des cervicogenic headache and analgesic induced headache, A combinatio n headache is defined by a daily tension-type headache superimposed wi th migraine attacks. According to modern pathophysiological concepts c entral changes in descending pain control systems interact with periph eral disturbances such as a raised myofascial pain sensitivity. Simple analgesics like acetylsalicylic acid and paracetamol, or ibuprofen an d naproxen as substitutes can be given occasionally or for short episo des of tension-type headache. For the long-term drug prophylaxis amitr iptyline is the first choice. Doxepine, clomipramine, mianserin, mapro tiline and the anticonvulsant valproate may also be used as alternativ es. The duration of treatment is at least six months. Additionally, or as an alternative behavioural medical procedures like stress training , relaxation techniques and biofeedback can be used. Acupuncture, accu pressure and transcutaneous nerve stimulation as well as physiotherapy or chiropractic procedures are of no proven benefit.