Emerging treatments

Botulinum toxin type A to pericranial muscles

The pathogenesis of tension-type headache (TTH) is unclear and the role of muscle tension is especially controversial. The release of muscle tension in craniofacial muscle by injecting botulinum toxin type A into pericranial muscles probably plays a minor role in its experimental relief of TTH. It has been shown to block the release of glutamate, substance P, and calcitonin gene-related peptide, which may lead to decreased sensory central nervous system input and a reduction of headache.[31] The results of various double-blind, placebo-controlled studies have been mixed and the use of botulinum toxin for chronic TTH is not currently recommended.[46][47][48]​ However, a more recent meta-analysis found that it was associated with significant improvements in standardised headache intensity, headache frequency, daily headache duration, and the frequency of acute pain medicine use compared with controls.[49]

Calcitonin gene-related peptide (CGRP) inhibitors

In clinical trials for migraine treatment, a reduction in non-migraine headaches (including TTH) has been observed with CGRP inhibitors.[50] Further studies are needed to investigate a possible role for CRGP inhibitors in TTH prevention.[3]

Nitric oxide synthase inhibitors

Given the involvement of nitric oxide in triggering TTH, inhibiting its synthesis through targeted interventions could offer a novel therapeutic approach. Investigating the efficacy and safety of nitric oxide synthase inhibitors in clinical trials may provide valuable insights into their potential as a treatment option for individuals suffering from chronic TTH. Further research in this area is warranted to better understand the therapeutic benefits and mechanisms of action associated with nitric oxide synthase inhibition.[3]

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