Field-testing The Diagnostic Criteria For Tension-type Headache And Evaluating The Preventive Treatment Of Tension-type Headache In Neurology Clinics

Background:The difficulty often encountered in primary headache is to discriminate between tension-type headache and mild migraine without aura. The standard diagnostic criteria for tension-type headache(TTH) might inculde individuals with headaches showing migrainous features. So stricter diagnostic criteria for tension-type headache were proposed in the appendix of The International Classification of Headache Disorders-II version(ICHD-II) and The International Classification of Headache Disorders-III beta version(ICHD-IIIβ).Objectives:This multi-center study attempted to test the diagnostic criteria for diagnosis of TTH in neurology clinics of 13 hospitals in Chongqing, and to evaluate the efficacy of preventive treatment in frequent episodic tension-type headache(ETTH) and chronic tension-type headache(CTTH).During the study period, we selected patients from neurology clinics of 13 hospitals in Chongqing and evaluated them by using a questionnair, doctors’ interview, diagnostic diary, and follow-up. Based on these, headache characteristics and associated symptoms were acquired. Prophylactic treatments were given to patients with frequent ETTH and CTTH. Face-to-face or telephone interviews were conducted to get headache conditions after one-month treatment.Results:A total of 116 patients were diagnosed as TTH, while 104(89.7%) of them classified as TTH according to the alterative criteria. If there is no standard criteria, the remaining 12(10.3%) patients were classified as unclassified headache. Compared with patients diagnosed according to the standard criteria, those diagnosed using the alternative criteria have no migraineous feature, such as photophobia, phonophobia, and nausea. In 104 patients, headache intensity was significantly high in TTH associated with pericranial tenderness when compared with those without pericranial tenderness.Six patients received lifestyle adjustment because their headache frequency is less than 12 days per year, while the other 110 patients reveived one of yangxueqingnao granule, amitriptyline and combination therapy. Among them, 5(4.5%) could not get in touch, 22(29.7%) had no improvement, 28(25.5%) cases untreated because of poor compliance, and 3Methods:(2.7%) develpoed intolerance to side effects of amitripline, and headache severity or headache days were significantly decreased in 52(70.3%) patients at the end of one-month treatment period. No serious adverse events.Conclusion:In our neurology clinics, the vast majority with TTH according to the standard criteria conformed to the alternative criteria. Our study demonstrated that some patients with TTH by the standard criteria could include people with headaches showing migrainous features. This study suggested that the alterative criteria could be used in clinical and research work to better identify migraine without typical symptoms,and prophylactic treatments, including traditional chinese medicine, could significantly reduce headache severity or headache days and have high safety.