The Experts below are selected from a list of 11547 Experts worldwide ranked by ideXlab platform
Jes Olesen - One of the best experts on this subject based on the ideXlab platform.
-
Chapter 3 – Tension-Type Headache
Neurological Disorders, 2020Co-Authors: Rigmor Jensen, Jes Olesen, H. Christoph DienerAbstract:Publisher Summary This chapter presents a discussion on Headache related to tension. The chapter states that the Tension-Type Headache is the most frequent Headache disorder and known by almost everyone. Despite the widespread prevalence, the pathophysiology behind Tension-Type Headache is widely unknown, and treatment strategies are still widely unspecific. Distinguishing episodic from chronic Tension-Type Headache and Tension-Type Headache from migraine has practical implications in management strategies. Chronic Tension-Type Headache is often associated with more severe pain and more accompanying symptoms, which is often combined with medication overuse, and is less influenced by daily hassles and stress than the episodic form. Episodes of Tension-Type Headache are more pronounced and frequent in subjects with coexisting migraine than in nonmigraineurs. This indicates that migraine can be a precipitating factor to Tension-Type Headache in genetically predisposed individuals. It can be extremely difficult to distinguish between several Headache disorders in the severely affected patients even in highly specialized Headache clinics. Therefore, a diagnostic Headache diary and a long-term follow-up are mandatory. A diagnosis of primary Headaches as Tension-Type Headache requires exclusion of other organic disorders. The principles of therapy discusses nonpharmacological treatment, pharmacological treatment, and prophylactic pharmacological treatment. Combined drugs consisting of analgesics, tranquilizers, and sedatives should be avoided because of the potential of habituation and subsequent analgesic rebound Headache phenomenon.
-
the relative influence of environment and genes in episodic tension type Headache
Neurology, 2004Co-Authors: V Ulrich, Morten Gervil, Jes OlesenAbstract:OBJECTIVE: To examine the relative importance of genetic and environmental influence for the development of Tension-Type Headache by analyses of twins. METHODS: The authors screened by questionnaire a population of 5,360 twins born during 1953 to 1960 from the general population for migraine and Headache symptoms. The response rate of the questionnaire was 87%. All twin pairs with at least one twin of the pair reporting migraine or Headache symptoms were interviewed by telephone by a physician. Correlation of liability and structural equation modeling were applied on Tension-Type Headache. RESULTS: A total of 1,417 subjects had Tension-Type Headache equivalent to a 1-year prevalence of 62%. The male: female ratio was 1:1.24. Chronic Tension-Type Headache was found in 49 twins corresponding to a prevalence of 2% with a male:female ratio of 1:1.21. The prevalence, pain characteristics, frequency, and duration of Tension-Type Headache were similar to what has been found in the general Danish population. The correlation of liability of Tension-Type Headache was low and not significantly different in monozygotic and dizygotic twin pairs: 0.21 (0.03 to 0.39), 0.08 (0 to 0.24). The best fitting model of phenotypic variation consisted of 81% non-shared environmental effects and of 19% additive genetic effects. CONCLUSIONS: Environmental influence is of major importance for episodic Tension-Type Headache and a genetic factor, if it exits, is minor. In chronic Tension-Type Headache the genetic factor may be more important. These data clearly separate episodic Tension-Type Headache from migraine without aura where the phenotypic variation consists of non-shared environmental effects of 39% and of 61% additive genetic effects.
-
Muscular Factors are of Importance in Tension‐Type Headache
Headache, 2003Co-Authors: Rigmor Jensen, Lars Bendtsen, Jes OlesenAbstract:Recent studies have indicated that muscular disorders may be of importance for the development of increased pain sensitivity in patients with chronic Tension-Type Headache. The objective of the present study was to investigate this hypothesis by examining the pain perception in Tension-Type Headache with and without muscular disorders defined as increased tenderness. We examined 28 patients with episodic Tension-Type Headache, 28 patients with chronic Tension-Type Headache, and 30 healthy controls. Pericranial myofascial tenderness was recorded with manual palpation, and pressure pain detection and tolerances in cephalic and extracephalic locations with an electronic pressure algometer. In addition, thermal pain sensitivity and electromyographic activity were recorded. The main result was significantly lower pressure pain detection thresholds and tolerances in all the examined locations in patients with chronic Tension-Type Headache with a muscular disorder compared to those without a muscular disorder. There were no such differences in any of the examined locations when the two subgroups of patients with episodic Tension-Type Headache were compared. Thermal pain sensitivity did not differ between patients with and without a muscular disorder, while electromyographic activity levels were significantly higher in patients with chronic Tension-Type Headache with than in those without a muscular disorder. Our results strongly indicate that prolonged nociceptive stimuli from the pericranial myofascial tissue sensitize the central nervous system and, thereby, lead to an increased general pain sensitivity. Muscular factors may, therefore, be of major importance for the conversion of episodic into chronic Tension-Type Headache. The present study complements the understanding of the important interactions between peripheral and central factors in Tension-Type Headache and may lead to a better prevention and treatment of the most prevalent type of Headache.
-
Inheritance of chronic Tension-Type Headache investigated by complex segregation analysis.
Human Genetics, 1998Co-Authors: Michael Bjørn Russell, Lennart Iselius, Steen Østergaard, Jes OlesenAbstract:We investigated the mode of inheritance of chronic Tension-Type Headache in 122 families. The probands were from the Copenhagen Headache Clinic, Denmark. The criteria of the International Headache Society were used. The patterns of segregation of chronic Tension-Type Headache were assessed by complex segregation analysis performed with the computer program POINTER. Of the 122 probands with chronic Tension-Type Headache, 56 had 71 first-degree relatives with chronic Tension-Type Headache. The complex segregation analysis indicates that chronic Tension-Type Headache has multifactorial inheritance.
-
muscular factors are of importance in tension type Headache
Headache, 1998Co-Authors: Rigmor Jensen, Lars Bendtsen, Jes OlesenAbstract:Recent studies have indicated that muscular disorders may be of importance for the development of increased pain sensitivity in patients with chronic Tension-Type Headache. The objective of the present study was to investigate this hypothesis by examining the pain perception in Tension-Type Headache with and without muscular disorders defined as increased tenderness. We examined 28 patients with episodic Tension-Type Headache, 28 patients with chronic Tension-Type Headache, and 30 healthy controls. Pericranial myofascial tenderness was recorded with manual palpation, and pressure pain detection and tolerances in cephalic and extracephalic locations with an electronic pressure algometer. In addition, thermal pain sensitivity and electromyographic activity were recorded. The main result was significantly lower pressure pain detection thresholds and tolerances in all the examined locations in patients with chronic Tension-Type Headache with a muscular disorder compared to those without a muscular disorder. There were no such differences in any of the examined locations when the two subgroups of patients with episodic Tension-Type Headache were compared. Thermal pain sensitivity did not differ between patients with and without a muscular disorder, while electromyographic activity levels were significantly higher in patients with chronic Tension-Type Headache with than in those without a muscular disorder. Our results strongly indicate that prolonged nociceptive stimuli from the pericranial myofascial tissue sensitize the central nervous system and, thereby, lead to an increased general pain sensitivity. Muscular factors may, therefore, be of major importance for the conversion of episodic into chronic Tension-Type Headache. The present study complements the understanding of the important interactions between peripheral and central factors in Tension-Type Headache and may lead to a better prevention and treatment of the most prevalent type of Headache.
Lars Bendtsen - One of the best experts on this subject based on the ideXlab platform.
-
drug treatment for episodic and chronic tension type Headache
2016Co-Authors: Lars Bendtsen, Sait AshinaAbstract:Tension-Type Headache (TTH) is a common primary Headache with tremendous socioeconomic impact. Simple analgesics are recommended for treatment of episodic Tension-Type Headache. There is evidence for efficacy of ibuprofen 200–800 mg, aspirin 500–1000 mg, paracetamol 1000 mg, ketoprofen 25 mg, naproxen 375–550 mg and diclofenac 12.5–100 mg. Combinations containing caffeine are recommended as drugs of second choice. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse Headache (MOH). Triptans are not indicated in the management of Tension-Type Headache. The tricyclic antidepressant amitriptyline 30–75 mg/day is drug of first choice for the prophylactic treatment of chronic Tension-Type Headache. Mirtazapine 15–30 mg/day and venlafaxine 150 mg/day are drugs of second choice.
-
Tension type Headache
Journal of Headache and Pain, 2013Co-Authors: Lars BendtsenAbstract:Primary Headaches represent some of the most costly diseases in modern society, and epidemiologic studies indicate that Tension-Type Headache and migraine represent two different diseases, although coexisting in many patients. Limited knowledge of the underlying pathophysiology of Tension-Type Headache is not yet available, and there is no specific treatment. In this paper, the clinical presentation of Tension-Type Headache is described, and treatment strategies for the acute episode as well as for the prophylaxis of chronic Tension-Type Headache are summarized. Simple analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute Headache and low dose tricyclic antidepressants are still the mainstays of treatment, although new promising therapies are emerging.
-
Pathophysiology of migraine and Tension-Type Headache
Techniques in Regional Anesthesia and Pain Management, 2013Co-Authors: Sait Ashina, Lars Bendtsen, Messoud AshinaAbstract:Abstract Migraine and Tension-Type Headache are common in general population. Recent progress in basic and clinical research has increased our understanding of pathophysiology of these Headaches. New treatment modalities and drugs for the treatment of these Headaches are emerging. Migraine is a neurovascular Headache with complex pathophysiology, which has not been fully clarified. Genes for both migraines, with and without aura, are being identified. Current research indicates importance of cortical spreading depression and abnormal brain stem activity in the pathophysiology of migraine with aura. The migraine Headache most likely originates in the sensory fibers innervating intracranial and extracranial blood vessels. Peripheral and central sensitization of trigeminovascular nociceptive pathways may develop during migraine attacks. Central sensitization of second- and third-order trigeminovascular nociceptive neurons may lead to transformation of episodic migraine to chronic migraine. Pericranial myofascial pain sensitivity is increased in patients with Tension-Type Headache and may be of importance in the pathophysiology of this Headache. Sensitization of second-order neurons at the level of the spinal dorsal horn or trigeminal nucleus, sensitization of supraspinal neurons, and decreased descending inhibition from supraspinal structures play a major role in the pathophysiology of chronic Tension-Type Headache.
-
Tension-Type Headache: mechanisms.
Handbook of Clinical Neurology, 2010Co-Authors: Lars Bendtsen, A Fumal, Jean SchoenenAbstract:Publisher Summary The chapter discusses the mechanisms of Tension-Type Headache (TTH). Tension-Type Headaches (TTHs) are very prevalent and responsible for substantial costs for both the individual and society. In contrast to migraine, no significant improvement in treatment possibilities has been seen in TTH within recent decades. Because of the enormous prevalence and variability in frequency and severity of TTH, any inheritance is almost certain to be polygenic. Sufferers of TTH must have many affected first-degree relatives. Headaches are generally reported to occur in relation to emotional conflict and psychosocial stress. Stress and mental tension are the most frequently reported precipitating factors but they occur with similar frequency in TTH and migraine. Peripheral factors have traditionally been considered of major importance in TTH and numerous studies have reported increased tenderness and hardness of pericranial myofascial tissues in these patients. The increased myofascial pain sensitivity in TTH could also be caused by central factors such as: (1) sensitization of second-order neurons at the level of the spinal dorsal horn/trigeminal nucleus; (2) sensitization of supraspinal neurons; and (3) decreased antinociceptive activity from supraspinal structures. The chapter elaborates on the model of Tension-Type Headache.
-
guidelines for controlled trials of drugs in tension type Headache second edition
Cephalalgia, 2010Co-Authors: Lars Bendtsen, D Mitsikostas, Rosanna Cerbo, Timothy J. Steiner, Kenneth A. Holroyd, Marcelo E Bigal, Christian Lampl, Hans-christoph Diener, Peer TfelthansenAbstract:The Clinical Trials Subcommittee of the International Headache Society published its first edition of the guidelines on controlled trials of drugs in Tension-Type Headache in 1995. These aimed ‘to improve the quality of controlled clinical trials in Tension-Type Headache’, because ‘good quality controlled trials are the only way to convincingly demonstrate the efficacy of a drug, and form the basis for international agreement on drug therapy’. The Committee published similar guidelines for clinical trials in migraine and cluster Headache. Since 1995 several studies on the treatment of episodic and chronic Tension-Type Headache have been published, providing new information on trial methodology for this disorder. Furthermore, the classification of the Headaches, including Tension-Type Headache, has been revised. These developments support the need for also revising the guidelines for drug treatments in Tension-Type Headache. These Guidelines are intended to assist in the design of well-controlled clinical ...
Rigmor Jensen - One of the best experts on this subject based on the ideXlab platform.
-
Chapter 3 – Tension-Type Headache
Neurological Disorders, 2020Co-Authors: Rigmor Jensen, Jes Olesen, H. Christoph DienerAbstract:Publisher Summary This chapter presents a discussion on Headache related to tension. The chapter states that the Tension-Type Headache is the most frequent Headache disorder and known by almost everyone. Despite the widespread prevalence, the pathophysiology behind Tension-Type Headache is widely unknown, and treatment strategies are still widely unspecific. Distinguishing episodic from chronic Tension-Type Headache and Tension-Type Headache from migraine has practical implications in management strategies. Chronic Tension-Type Headache is often associated with more severe pain and more accompanying symptoms, which is often combined with medication overuse, and is less influenced by daily hassles and stress than the episodic form. Episodes of Tension-Type Headache are more pronounced and frequent in subjects with coexisting migraine than in nonmigraineurs. This indicates that migraine can be a precipitating factor to Tension-Type Headache in genetically predisposed individuals. It can be extremely difficult to distinguish between several Headache disorders in the severely affected patients even in highly specialized Headache clinics. Therefore, a diagnostic Headache diary and a long-term follow-up are mandatory. A diagnosis of primary Headaches as Tension-Type Headache requires exclusion of other organic disorders. The principles of therapy discusses nonpharmacological treatment, pharmacological treatment, and prophylactic pharmacological treatment. Combined drugs consisting of analgesics, tranquilizers, and sedatives should be avoided because of the potential of habituation and subsequent analgesic rebound Headache phenomenon.
-
tension type Headache
Neurologic Clinics, 2009Co-Authors: Lars Bendtsen, Rigmor JensenAbstract:The substantial societal and individual burdens associated with Tension-Type Headache (TTH) constitute a previously overlooked major public health issue. TTH is prevalent, affecting up to 78% of the general population, and 3% suffer from chronic TTH. Pericranial myofascial nociception probably is important for the pathophysiology of episodic TTH, whereas sensitization of central nociceptive pathways seems responsible for the conversion of episodic to chronic TTH. Headache-related disability usually can be reduced by identification of trigger factors combined with nonpharmacologic and pharmacologic treatments, but effective treatment modalities are lacking. Benefits can be gained by development of specific and effective treatment strategies.
-
prognosis of migraine and tension type Headache a population based follow up study
Neurology, 2005Co-Authors: A C Lyngberg, Birthe Krogh Rasmussen, Torben Jorgensen, Rigmor JensenAbstract:Objective: To determine the prognosis of migraine and Tension-Type Headache and to identify prognostic factors. Methods: Of 740 persons (aged 25 to 64 years) examined in a 1989 Danish cross-sectional Headache study, 673 were eligible for follow-up in 2001. All interviews at baseline and at follow-up were conducted by medical doctors and based on the 1988 IHS-criteria. Results: A total of 549 persons (81.6%) participated in the follow-up study. Of 64 migraineurs at baseline, 42% had experienced remission, 38% had low migraine frequency, and 20% had more than 14 migraine days per year (poor outcome) at follow-up. Poor outcome was associated with high migraine frequency at baseline and age at onset younger than 20 years. Among 146 subjects with frequent episodic Tension-Type Headache and 15 with chronic Tension-Type Headache at baseline, 45% experienced infrequent or no Tension-Type Headache (remission), 39% had frequent episodic Tension-Type Headache, and 16% experienced chronic Tension-Type Headache (poor outcome) at follow-up. Poor outcome was associated with baseline chronic Tension-Type Headache, coexisting migraine, not being married, and sleeping problems. Conclusions: The prognosis of migraine, frequent episodic Tension-Type Headache, and chronic Tension-Type Headache was favorable.
-
Muscular Factors are of Importance in Tension‐Type Headache
Headache, 2003Co-Authors: Rigmor Jensen, Lars Bendtsen, Jes OlesenAbstract:Recent studies have indicated that muscular disorders may be of importance for the development of increased pain sensitivity in patients with chronic Tension-Type Headache. The objective of the present study was to investigate this hypothesis by examining the pain perception in Tension-Type Headache with and without muscular disorders defined as increased tenderness. We examined 28 patients with episodic Tension-Type Headache, 28 patients with chronic Tension-Type Headache, and 30 healthy controls. Pericranial myofascial tenderness was recorded with manual palpation, and pressure pain detection and tolerances in cephalic and extracephalic locations with an electronic pressure algometer. In addition, thermal pain sensitivity and electromyographic activity were recorded. The main result was significantly lower pressure pain detection thresholds and tolerances in all the examined locations in patients with chronic Tension-Type Headache with a muscular disorder compared to those without a muscular disorder. There were no such differences in any of the examined locations when the two subgroups of patients with episodic Tension-Type Headache were compared. Thermal pain sensitivity did not differ between patients with and without a muscular disorder, while electromyographic activity levels were significantly higher in patients with chronic Tension-Type Headache with than in those without a muscular disorder. Our results strongly indicate that prolonged nociceptive stimuli from the pericranial myofascial tissue sensitize the central nervous system and, thereby, lead to an increased general pain sensitivity. Muscular factors may, therefore, be of major importance for the conversion of episodic into chronic Tension-Type Headache. The present study complements the understanding of the important interactions between peripheral and central factors in Tension-Type Headache and may lead to a better prevention and treatment of the most prevalent type of Headache.
-
Mechanisms of Tension-Type Headache.
Cephalalgia, 2001Co-Authors: Rigmor JensenAbstract:Despite Tension-Type Headache represents one of the most frequent and costly diseases in modern society only very little research on this disease has actually been carried out. In contrast to former belief Tension-Type Headache is a separate entity that can and should be separated from migraine. No specific biochemical abnormalities have yet been identified but a reliable human model of Tension-Type Headache has been developed by means of infusion of a NO-donor, glyceryl trinitrate. Myofascial factors and peripheral sensitization of nociceptors play an important role in the episodic form, and central sensitization has been demonstrated in the chronic form. As chronic Tension-Type Headache usually evolves from the episodic form, prevention and reversal of this central sensitization may be an important target for future pathophysiological studies and drug development.
R Jensen - One of the best experts on this subject based on the ideXlab platform.
-
generalized hyperalgesia in patients with chronic tension type Headache
Cephalalgia, 2006Co-Authors: Sait Ashina, Lars Bendtsen, Messoud Ashina, Walter Magerl, R JensenAbstract:Increased pain sensitivity in the central nervous system may play an important role in the pathophysiology of chronic Tension-Type Headache (CTTH). Previous studies using pain thresholds as a measu...
-
initiating mechanisms of experimentally induced tension type Headache
Cephalalgia, 1996Co-Authors: R Jensen, Jes OlesenAbstract:To elucidate possible myofascial mechanisms of Tension-Type Headache, the effect of 30 min of sustained tooth clenching (10% of maximal EMG-signal) was studied in 58 patients with Tension-Type Headache and in 30 age- and sex-matched controls. Pericranial tenderness, mechanical and thermal pain detection and tolerance thresholds and FMG levels were recorded before and after the clenching procedure. Within 24 h, 69% of patients and 17% of controls developed a Tension-Type Headache. Shortly after clenching, tenderness was increased in the group who subsequently developed Headache, whereas tenderness was stable in the group of patients who remained Headache free. Mechanical pain thresholds evaluated by pressure algometry remained unchanged in the group which developed Headache, whereas thresholds increased in the group which did not develop Headache Thermal pain detection and tolerance thresholds remained unchanged in both groups. These findings indicate that, though there may be several different mechanisms ...
Messoud Ashina - One of the best experts on this subject based on the ideXlab platform.
-
Tension-Type Headache
NATIONAL JOURNAL OF NEUROLOGY, 2019Co-Authors: Messoud Ashina, Sait AshinaAbstract:Tension-Type Headache is the most common primary Headache disorder. The life-time prevalence of Tension-Type Headache in general population is between 30 to 78%. Tension-Type has the tremendous socio-economic impact on the individual and the society. Unfortunately, it is the least studied primary Headache. The pathophysiology of this Headache disorder is not fully understood. The diagnosis of Tension-Type Headache is based on the history, and general and neurological examinations. Abnormalities in peripheral and central nociceptive nervous systems in combination with environmental and genetic factors may play a role in the pathophysiology of Tension-Type Headache. The pharmacotherapy of episodic Tension-Type Headache is non-specific and includes simple analgesics and nonsteroidal anti-inflammatory drugs. Tricyclic antidepressants are the mainstay in the prophylactic treatment of chronic Tension-Type Headache.
-
Pathophysiology of migraine and Tension-Type Headache
Techniques in Regional Anesthesia and Pain Management, 2013Co-Authors: Sait Ashina, Lars Bendtsen, Messoud AshinaAbstract:Abstract Migraine and Tension-Type Headache are common in general population. Recent progress in basic and clinical research has increased our understanding of pathophysiology of these Headaches. New treatment modalities and drugs for the treatment of these Headaches are emerging. Migraine is a neurovascular Headache with complex pathophysiology, which has not been fully clarified. Genes for both migraines, with and without aura, are being identified. Current research indicates importance of cortical spreading depression and abnormal brain stem activity in the pathophysiology of migraine with aura. The migraine Headache most likely originates in the sensory fibers innervating intracranial and extracranial blood vessels. Peripheral and central sensitization of trigeminovascular nociceptive pathways may develop during migraine attacks. Central sensitization of second- and third-order trigeminovascular nociceptive neurons may lead to transformation of episodic migraine to chronic migraine. Pericranial myofascial pain sensitivity is increased in patients with Tension-Type Headache and may be of importance in the pathophysiology of this Headache. Sensitization of second-order neurons at the level of the spinal dorsal horn or trigeminal nucleus, sensitization of supraspinal neurons, and decreased descending inhibition from supraspinal structures play a major role in the pathophysiology of chronic Tension-Type Headache.
-
Pathophysiology of Tension-Type Headache: potential drug targets.
Cns & Neurological Disorders-drug Targets, 2007Co-Authors: Messoud AshinaAbstract:: The pathophysiology of Tension-Type Headache is still far from clear, although recent advances in basic and clinical research have increased our knowledge about mechanisms underlying this disorder. Experimental studies suggest that increased excitability of the CNS generated by repetitive and sustained pericranial myofascial input may be responsible for transformation of episodic Tension-Type Headache into chronic form. Future studies should focus on the identification of the source of peripheral nociception in patients with Tension-Type Headache and the development of more effective and specific treatment modalities.
-
generalized hyperalgesia in patients with chronic tension type Headache
Cephalalgia, 2006Co-Authors: Sait Ashina, Lars Bendtsen, Messoud Ashina, Walter Magerl, R JensenAbstract:Increased pain sensitivity in the central nervous system may play an important role in the pathophysiology of chronic Tension-Type Headache (CTTH). Previous studies using pain thresholds as a measu...
-
Pathophysiology of Tension-Type Headache.
Current Pain and Headache Reports, 2005Co-Authors: Sait Ashina, Lars Bendtsen, Messoud AshinaAbstract:Tension-Type Headache is one of the most common primary Headache disorders. Advances in basic pain and clinical research have improved our understanding of pathophysiologic mechanisms of Tension-Type Headache. Increased excitability of the central nervous system generated by repetitive and sustained pericranial myofascial input may be responsible for the transformation of episodic Tension-Type Headache into the chronic form. Studies of nitric oxide (NO) mechanisms suggest that NO may play a key role in the pathophysiology of Tension-Type Headache and that the antinociceptive effect of nitric oxide synthase inhibitors may become a novel principle in the future treatment of chronic Headache. Future studies should focus on investigation of the source of peripheral nociception, the role of descending pain modulation, and the development of an animal model of Tension-Type Headache to support the pathophysiologic importance of central sensitization in Tension-Type Headache.
