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Episodic tension headache (TTH) and migraine, both categorized as primary headache types, account for 60-90% of headache complaints and are three times more common among young women. This study aimed to explore the comparative effectiveness of progressive relaxation training (PRT) on pain characteristics, attack frequency, activity self-efficacy, and pain-related disability in women with episodic TTH and migraine. This study was registered at ClinicalTrials.gov (NCT06050382). This prospective study included women with episodic TTH (n=20) and migraine (n=20). The pain intensity, impact of headaches on life, activity self-efficacy, pain catastrophizing, and pain-related disability levels of both groups were measured using the Visual Analog Scale (VAS), Headache Impact Test (HIT-6), Occupational Self-Assessment Scale (OSAS), Pain Catastrophizing Scale (PCS), and World Health Organization Disability Assessment Schedule 2 (WHODAS-II) pre- and post-intervention, respectively. Both TTH and migraine groups received PRT twice a week for six weeks. Within-group comparisons showed significant decreases in attack frequency, VAS, HIT-6, PCS, and WHODAS-II scores in both groups post-intervention (p<0.001). Also, both groups showed an increase in OSAS proficiency scores (p<0.001). The between-group comparison showed that the attack frequency, VAS, HIT-6, PCS, and WHODAS-II scores were lower in the migraine group than the TTH group. However, all sub-scores of the OSAS were higher in the migraine group (p<0.001). PRT showed positive effects on pain intensity, attack frequency, activity self-efficacy, and pain-related disability in both groups, more so in the TTH group.

Background and aim Tension-type headache is the most prevalent primary headache disorder. While the episodic subtype is more common, chronic tension-type headache significantly impacts health-related quality of life and contribute to increased healthcare utilization and disability. Despite considerable advances in the understanding of tension-type headache, critical gaps persist. This paper aims to provide a comprehensive review of the hallmarks of tension-type headache, from its pathophysiology, comorbidities, treatment options, to psychosocial impact. Main results Multiple factors are associated with tension-type headache, including peripheral mechanisms (increased muscle tenderness and myofascial trigger points), central sensitization, genetic predisposition, and psychological comorbidities such as anxiety and depression. Neuroimaging and neurophysiological studies demonstrated altered pain processing in cortical and subcortical regions in patients with tension-type headache. Regarding treatment strategy, in addition to pharmacological treatment, novel insights into non-pharmacological interventions such as cognitive behavioral therapy, neuromodulation techniques, physical therapy, mindfulness, lifestyle management, and patient education were highlighted as valuable components of comprehensive management strategies. Conclusions A complex interplay between peripheral and central mechanisms and psychosocial stressors underpins tension-type headache. Integrated multidisciplinary approaches combining pharmacological and non-pharmacological interventions are critical for optimal patient outcomes. Further research should continue to refine the understanding of these mechanisms to improve targeted therapeutic strategies and reduce the global burden of tension-type headache.

Headaches are a common source of pain and suffering. The study's purpose was to assess beta-blockers efficacy in preventing migraine and tension-type headache. Cochrane Register of Controlled Trials; MEDLINE; EMBASE; ISI Web of Science, clinical trial registries, CNKI, Wanfang and CQVIP were searched through 21 August 2018, for randomized trials in which at least one comparison was a beta-blocker for the prevention of migraine or tension-type headache in adults. The primary outcome, headache frequency per month, was extracted in duplicate and pooled using random effects models. This study included 108 randomized controlled trials, 50 placebo-controlled and 58 comparative effectiveness trials. Compared to placebo, propranolol reduced episodic migraine headaches by 1.5 headaches/month at 8 weeks (95% CI: -2.3 to -0.65) and was more likely to reduce headaches by 50% (RR: 1.4, 95% CI: 1.1-1.7). Trial Sequential Analysis (TSA) found that these outcomes were unlikely to be due to a Type I error. A network analysis suggested that beta-blocker's benefit for episodic migraines may be a class effect. Trials comparing beta-blockers to other interventions were largely single, underpowered trials. Propranolol was comparable to other medications known to be effective including flunarizine, topiramate and valproate. For chronic migraine, propranolol was more likely to reduce headaches by at least 50% (RR: 2.0, 95% CI: 1.0-4.3). There was only one trial of beta-blockers for tension-type headache. There is high quality evidence that propranolol is better than placebo for episodic migraine headache. Other comparisons were underpowered, rated as low-quality based on only including single trials, making definitive conclusions about comparative effectiveness impossible. There were few trials examining beta-blocker effectiveness for chronic migraine or tension-type headache though there was limited evidence of benefit. Prospero (ID: CRD42017050335).

Although tension-type headache (TTH) is a frequent type of headache disorder and imposes a significant burden, there is scant information about the prevalence and impact of comorbid anxiety and depression among individuals with TTH. We investigated the prevalence and clinical impact of anxiety and depression among patients with TTH in the general population. We recruited Korean participants aged 19-69 years using a two-stage clustered random sampling method. To identify the presence of headache type, anxiety, and depression, we used a semi-structured interview using certain questionnaires. To assess the level of anxiety and depression, we used the Goldberg Anxiety Scale and Patient Health Questionnaire-9, respectively. Among 2,695 participants, 570 people (21.2%) had TTH during previous 1 year. In participants with TTH, the prevalence of anxiety (9.5% vs. 5.3%, p = 0.001) and depression (4.2% vs. 1.8%, p = 0.001) was significantly higher than that of non-headache participants. The prevalence of anxiety among TTH participants with >15 attacks per month [21.4%, odds ratio (OR): 4.0] and 1-14 attacks per month (13.1%, OR: 2.2) was higher than that in those with <1 attack per month (6.4%), however this tendency was not observed in participants with depression. Visual Analogue Scale (VAS) score [median 5.0 vs. 4.0, p = 0.010] and Headache Impact Test-6 (HIT-6) score [median 45.5 vs. 42.0, p < 0.001] were significantly higher among those with anxiety. Furthermore, VAS scores [median 5.0 vs. 4.0, p = 0.010] and HIT-6 scores [median 45.5 vs. 42.0, p = 0.027] were also significantly higher among TTH patients with depression than among those without depression. In conclusion, anxiety and depression were more prevalent in participants with TTH than in non-headache participants. These two conditions were associated with an exacerbation of headache symptoms in individuals with TTH.

Background: Mindfulness-based therapy (MBT) has been demonstrated to be effective for reducing chronic pain symptoms; however, the use of MBT for Chronic Tension-Type Headache (CTH) exclusively has to date not been examined. Typically, MBT for chronic pain has involved an 8-week program based on Mindfulness Based Stress Reduction. Recent research suggests briefer mindfulness-based treatments may be effective for chronic pain. Aims: To conduct a pilot study into the efficacy of brief MBT for CTH. Method: We conducted a randomized controlled trial of a brief (6-session, 3-week) MBT for CTH. Results: Results indicated a significant decrease in headache frequency and an increase in the mindfulness facet of Observe in the treatment but not wait-list control group. Conclusion: Brief MBT may be an effective intervention for CTH.

Through the Global Burden of Diseases, Injuries, and Risk Factors (GBD) studies, headache has emerged as a major global public health concern. We aimed to use data from the GBD 2016 study to provide new estimates for prevalence and years of life lived with disability (YLDs) for migraine and tension-type headache and to present the methods and results in an accessible way for clinicians and researchers of headache disorders. Data were derived from population-based cross-sectional surveys on migraine and tension-type headache. Prevalence for each sex and 5-year age group interval (ie, age 5 years to ≥95 years) at different time points from 1990 and 2016 in all countries and GBD regions were estimated using a Bayesian meta-regression model. Disease burden measured in YLDs was calculated from prevalence and average time spent with headache multiplied by disability weights (a measure of the relative severity of the disabling consequence of a disease). The burden stemming from medication overuse headache, which was included in earlier iterations of GBD as a separate cause, was subsumed as a sequela of either migraine or tension-type headache. Because no deaths were assigned to headaches as the underlying cause, YLDs equate to disability-adjusted life-years (DALYs). We also analysed results on the basis of the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility. Almost three billion individuals were estimated to have a migraine or tension-type headache in 2016: 1·89 billion (95% uncertainty interval [UI] 1·71–2·10) with tension-type headache and 1·04 billion (95% UI 1·00–1·09) with migraine. However, because migraine had a much higher disability weight than tension-type headache, migraine caused 45·1 million (95% UI 29·0–62·8) and tension-type headache only 7·2 million (95% UI 4·6–10·5) YLDs globally in 2016. The headaches were most burdensome in women between ages 15 and 49 years, with migraine causing 20·3 million (95% UI 12·9–28·5) and tension-type headache 2·9 million (95% UI 1·8–4·2) YLDs in 2016, which was 11·2% of all YLDs in this age group and sex. Age-standardised DALYs for each headache type showed a small increase as SDI increased. Although current estimates are based on limited data, our study shows that headache disorders, and migraine in particular, are important causes of disability worldwide, and deserve greater attention in health policy debates and research resource allocation. Future iterations of this study, based on sources from additional countries and with less methodological heterogeneity, should help to provide stronger evidence of the need for action. Bill & Melinda Gates Foundation.

The authors prove the existence and the linear stability of small amplitude time quasi-periodic standing wave solutions (i.e. periodic and even in the space variable x) of a 2-dimensional ocean with infinite depth under the action of gravity and surface tension. Such an existence result is obtained for all the values of the surface tension belonging to a Borel set of asymptotically full Lebesgue measure.

The Hubble tension has now grown to a level of significance which can no longer be ignored and calls for a solution which, despite a huge number of attempts, has so far eluded us. Significant efforts in the literature have focused on early-time modifications of ΛCDM, introducing new physics operating prior to recombination and reducing the sound horizon. In this opinion paper I argue that early-time new physics alone will always fall short of fully solving the Hubble tension. I base my arguments on seven independent hints, related to (1) the ages of the oldest astrophysical objects, (2) considerations on the sound horizon-Hubble constant degeneracy directions in cosmological data, (3) the important role of cosmic chronometers, (4) a number of “descending trends” observed in a wide variety of low-redshift datasets, (5) the early integrated Sachs-Wolfe effect as an early-time consistency test of ΛCDM, (6) early-Universe physics insensitive and uncalibrated cosmic standard constraints on the matter density, and finally (7) equality wavenumber-based constraints on the Hubble constant from galaxy power spectrum measurements. I argue that a promising way forward should ultimately involve a combination of early- and late-time (but non-local—in a cosmological sense, i.e., at high redshift) new physics, as well as local (i.e., at z∼0) new physics, and I conclude by providing reflections with regards to potentially interesting models which may also help with the S8 tension.

Background Limited population-based data as well as proposed mechanisms of retinal ganglion cell (RGC) loss suggest autoimmune disease may be a risk factor for glaucoma, the leading cause of irreversible blindness worldwide. Though intraocular pressure (IOP) is the leading risk factor for glaucoma onset and progression, a subset of glaucoma referred to as normal tension glaucoma (NTG) may be more likely to be associated with IOP-independent mechanisms of RGC injury including those of an inflammatory or immune nature. Methods This retrospective case-control study enrolled 277 patients with NTG and the same number of age- and sex-matched controls to determine whether autoimmune disease diagnosis, treatment thereof, or relevant laboratory markers are associated with NTG. Results There was no significant difference between the two groups in frequency of autoimmune disease overall, autoimmune disease catagorized by mechanism or organ involvement, or individual autoimmune disease including psoriasis (6% vs. 5%), rheumatoid arthritis (5% vs. 4%), inflammatory bowel disease (2% vs. 3%), Sjögren’s syndrome (1% vs. 1%), sarcoidosis (1% vs. 1%), autoimmune thyroiditis (1% vs. 0%), type 1 diabetes (1% vs. 0%), or systemic lupus erythematosus (1% vs. 0%). There was also no significant difference in laboratory values or treatment of identified autoimmune conditions. Conclusions Our study found no significant association between autoimmune disease and NTG, suggesting that other factors may play a more significant role in the pathogenesis of NTG.