Intra-oral orthosis vs amitriptyline in chronic tension-type headache: a clinical and laser evoked potentials study

Eighteen patients with diagnosed CTTH participated in this open label, controlled study. A baseline evaluation was performed for clinical features, Total Tenderness Score (TTS) and a topographic analysis of LEPs obtained manually and the pericranial points stimulation in all patients vs. healthy subjects. Thereafter, patients were randomly assigned to a two-month treatment by either amitriptyline or intra-oral appliance.Both the intra-oral appliance and amitriptyline significantly reduced headache frequency. The TTS was significantly reduced in the group treated with the appliance. The amplitude of P2 response elicited by stimulation of pericranial zones showed a reduction after amitriptyline treatment.Both therapies were effective in reducing headache severity, the appliance with a prevalent action on the pericranial muscular tenderness, amitriptyline reducing the activity of the central cortical structures subtending pain elaborationThe results of this study may suggest that in CTTH both the interventions at the peripheral and central levels improve the outcome of headache.Although tension-type headache is the most common type of primary headache, its pathophysiology is poorly understood. The best documented abnormality in patients with tension type headache is increased pericranial myofascial tenderness [1,2]. Pericranial tenderness has been shown to be positively associated with both the intensity and the frequency of tension type headache [2,3]. It is generally accepted that myofascial tenderness probably plays a key role in the pathophysiology of tension type headache. Recently, a pathophysiological model for tension type headache has been proposed. Accordingly, the main problem is central sensitization at the level of the spinal dorsal horn/trigeminal nucleus, resulting from prolonged nociceptive inputs from pericranial myofascial tissues. This central sensitization is posited to cause supraspinal sensitization and central neuroplastic changes, that possibly