EFNS guideline on the treatment of tension-type headache - Report of an EFNS task force
EFNS guideline on the treatment of tension-type headache - Report of an EFNS task force
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DOI：
10.1111/j.1468-1331.2010.03070.x
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发表时间：
2010-11-01
影响因子：
5.1
通讯作者：
Schoenen, J.
中科院分区：
文献类型：
--
作者：
Bendtsen, L.;Evers, S.;Schoenen, J.
背景：紧张型头痛 (TTH) 是最常见的头痛类型，会导致高度残疾。频繁的 TTH 的治疗往往很困难。目的：基于文献检索和专家小组的共识，为 TTH 的不同治疗方案提供基于证据或专家的建议。方法：筛选所有可用的医学参考系统中的 TTH 临床研究范围。这些研究的结果根据 EFNS 的建议进行评估，得出 A、B 或 C 级建议和良好实践要点。建议：尽管科学依据有限，但仍应考虑非药物管理。信息、保证和识别触发因素可能是有益的。肌电图 (EMG) 生物反馈在 TTH 中具有已证实的效果，而认知行为疗法和放松训练很可能有效。对于频繁发生 TTH 的患者来说，物理治疗和针灸可能是有价值的选择，但没有强有力的科学证据证明其疗效。建议使用简单的镇痛药和非甾体类抗炎药来治疗阵发性 TTH。含有咖啡因的复方镇痛药是第二选择的药物。不应使用曲普坦类药物、肌肉松弛剂和阿片类药物。避免频繁和过度使用镇痛药对于预防药物过度使用性头痛的发生至关重要。三环类抗抑郁药阿米替林是预防性治疗慢性 TTH 的首选药物。米氮平和文拉法辛是第二选择的药物。预防性药物的功效通常是有限的，并且副作用可能会阻碍治疗。
Background:Tension-type headache (TTH) is the most prevalent headache type and is causing a high degree of disability. Treatment of frequent TTH is often difficult.Objectives:To give evidence-based or expert recommendations for the different treatment procedures in TTH based on a literature search and the consensus of an expert panel.Methods:All available medical reference systems were screened for the range of clinical 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 the scientific basis is limited. Information, reassurance and identification of trigger factors may be rewarding. Electromyography (EMG) biofeedback has a documented effect in TTH, whilst cognitive-behavioural therapy and relaxation training most likely are effective. Physical therapy and acupuncture may be valuable options for patients with frequent TTH, but there is no robust scientific evidence for efficacy. Simple analgesics and non-steroidal anti-inflammatory drugs are recommended for the treatment of episodic TTH. Combination analgesics containing caffeine are drugs of second choice. Triptans, muscle relaxants and opioids should not be used. 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 of second choice. The efficacy of the prophylactic drugs is often limited, and treatment may be hampered by side effects.