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Tension-type headache 

Tension-type headache
Tension-type headache

Lars Bendtsen

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date: 14 August 2020

Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact.

Non-pharmacological management is crucial, and information, reassurance, and identification of trigger factors can be effective.

Psychological treatments with scientific evidence for efficacy include relaxation training, electromyographic biofeedback, and cognitive behavioural therapy.

Physical therapy and acupuncture are widely used, but the scientific evidence for efficacy is sparse.

Simple analgesics are the mainstays for treatment of episodic TTH.

Combination analgesics, triptans, muscle relaxants, and opioids should not be used, and it is crucial to avoid frequent and excessive use of simple analgesics to prevent the development of medication overuse headache.

The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic management of chronic TTH.

The development of specific non-pharmacological and pharmacological managements for TTH with higher efficacy and fewer side-effects is urgently needed.

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