Advances in the Pathophysiology of Tension-type Headache: From Stress to Central Sensitization

Current Pain and Headache Reports 2009, 13:484-494 Current Medicine Group  LLC ISSN 1531-3433 Copyright © 2010 by Current Medicine Group LLC

Yaniv Chen, MDCM

Corresponding author:
Yaniv Chen, MDCM
Department of Neurology, NYU Medical Center, New York University, 550 First Avenue, New York, NY, 10016.
Email: yaniv.chen@nyumc.org

Tension-type headache (TTH) is the most common and most socioeconomically costly headache.
Yet our knowledge regarding TTH pathophysiological mechanisms is still in its early stages. Psychological stress and weak coping mechanisms may initiate and propagate physiological pain via activation of second messengers in downstream substrates involved in pain.

It seems that peripheral mechanisms are predominant in the episodic type (ETTH), whereas central mechanisms are involved in the chronic type (CTTH) of tension headache.

The conversion from ETTH to CTTH is most relevant to the clinician and the patient, as CTTH is the most debilitating.

This paper focuses and summarizes our current understanding of central sensitization, the process by which this conversion occurs in TTH, and proposes an integrated model to explain how ETTH progresses into CTTH in genetically susceptible individuals.

Acute Treatment of Migraine Headaches

	Seminars in Neurology 2010; 30(2): 145-153 DOI: 10.1055/s-0030-1249223
© Thieme Medical Publishers
Frederick R. Taylor1,2
1 Headache Clinic and Research Center, Park Nicollet Health Services, Minneapolis, Minnesota 2 University of Minnesota School of Medicine, Minneapolis, Minnesota

ABSTRACT

Optimum acute treatment of migraine requires prevention of headache as a top priority. Recognition of the multitude of migraine presentations, the frequency of total headache attacks, and number of days of headache disability are critical.
 
Successful treatment requires excellent patient-clinician communication enhancing confidence and mutual trust based on patient needs and preferences.

Optimum management of acute migraine nearly always requires pharmacologic treatment for rapid resolution.
Migraine-specific triptans, dihydroergotamine, and several antiinflammatories have substantial empirical clinical efficacy.
Older nonspecific drugs, particularly butalbital and opioids, contribute to medication overuse headache and are to be avoided.
Clinicians should utilize evidence-based acute migraine-specific therapy stressing the imperative acute treatment goal of early intervention, but not too often with the correct drug, formulation, and dose. This therapy needs to provide cost-effective fast results, meaningful to the patient while minimizing the need for additional drugs.

Migraine-ACT evaluates 2-hour pain freedom with return to normal function, comfort with treatment, and consistency of response. Employ a thoroughly educated patient, formulary, testimonials, stratification, and rational cotherapy against the race to central sensitization for optimum outcomes.