Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache
SOURCE: Duke University Evidence-based Practice Center
Douglas C. McCrory, MD, MHSc, Donald B. Penzien, PhD,
Vic Hasselblad, PhD. Rebecca N. Gray, DPhil
Duke University Evidence-based Practice Center
Center for Clinical Health Policy Research
2200 W. Main Street, Suite 230
Durham, NC 27705
Tension-type headache and cervicogenic headache are two of the most common non-migraine headaches. Population-based studies suggest that a large proportion of adults experience mild and infrequent (once per month or less) tension-type headaches, and that the one-year prevalence of more frequent headaches (more than once per month) is 20%-30%; a smaller percentage of the population (roughly 3%) has been estimated to have chronic tension-type headache (180 days per year). Estimates of the prevalence of cervicogenic headache have varied considerably, due in large part to disagreements about the precise definition of the condition. A recent population-based study, which used the diagnostic criteria of the International Headache Society (IHS), found that 17.8% of subjects with frequent headache (5 days per month) fulfilled the criteria for cervicogenic headache; this was equivalent to a prevalence of 2.5% in the larger population. This agrees with an earlier clinic-based study which found that 14% of headache patients treated had cervicogenic headache.
The impact of tension-type headache on individuals and society appears to be significant. According to one population-based study, regular activities were limited during 38% of tension-type headache attacks, and 4% of respondents indicated that their headaches affected their attendance at work. Eighty-nine percent of tension-type headache sufferers reported that their headaches had negatively affected their relationships with friends, colleagues, and family. Little is known about the personal and societal impact of cervicogenic headache.
Nearly all patients with tension-type headache have used medications at one time or another to treat their headaches. But pharmacological treatments are not suitable for all patients, nor are they universally effective. Drug treatments may also produce undesired side effects. Partly for these reasons, significant interest has developed among both patients and health care providers in alternative treatments for tension-type headache, including behavioral and physical interventions. Cervicogenic headache, when diagnosed as such, is commonly treated with non-pharmacological interventions, especially physical treatments.
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