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Efficacy of Regular Sauna Bathing for Chronic Tension-Type Headache: A Randomized Controlled Study

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  • The Sports and Pain Clinic

Abstract and Figures

Objective: Chronic tension-type headache (CTTH) is a chronic syndrome characterized by frequent headache occurring more than 15 days per month. The intensity and duration of headache pain can be very distressing and disabling on an individuals' well-being. The purpose of this study was to examine the applicability of sauna bathing as a new method of treatment for reducing pain in patients with CTTH. Methods: Thirty-seven people who fulfilled the International Headache Society criteria for CTTH were randomly assigned into two groups. The control group (n=20) received advice and education while the intervention group (n=17) received the same advice and attended a sauna regularly for 8 weeks. Reductions in subjective pain were determined using the numerical pain rating scale (NPRS). Disturbance in sleep, depression as assessed by Beckman Disability Index (BDI), and Headache Disability Index (HDI) were measured. Results: Mean change in headache intensity significantly differed between the sauna and control group by 1.27 (95% confidence interval, 0.48-2.07; F=10.17; df=1, 117; p=0.002). There was no statistically significant change in duration of headache or improvement in sleep, depression, or HDI between the sauna and control groups. Conclusion: Regular sauna bathing is a simple, self-directed treatment that is effective for reducing headache pain intensity in CTTH.
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Efficacy of Regular Sauna Bathing for Chronic
Tension-Type Headache:
A Randomized Controlled Study
Giresh Kanji, PhD,
1
Mark Weatherall, FRACP,
2
Raja Peter, PhD,
3
Gordon Purdie, BSc,
4
and Rachel Page, PhD
5
Abstract
Objective: Chronic tension-type headache (CTTH) is a chronic syndrome characterized by frequent headache
occurring more than 15 days per month. The intensity and duration of headache pain can be very distressing and
disabling on an individuals’ well-being. The purpose of this study was to examine the applicability of sauna
bathing as a new method of treatment for reducing pain in patients with CTTH.
Methods: Thirty-seven people who fulfilled the International Headache Society criteria for CTTH were ran-
domly assigned into two groups. The control group (n=20) received advice and education while the inter-
vention group (n=17) received the same advice and attended a sauna regularly for 8 weeks. Reductions in
subjective pain were determined using the numerical pain rating scale (NPRS). Disturbance in sleep, depression
as assessed by Beckman Disability Index (BDI), and Headache Disability Index (HDI) were measured.
Results: Mean change in headache intensity significantly differed between the sauna and control group by 1.27
(95% confidence interval, 0.48–2.07; F=10.17; df =1, 117; p=0.002). There was no statistically significant
change in duration of headache or improvement in sleep, depression, or HDI between the sauna and control groups.
Conclusion: Regular sauna bathing is a simple, self-directed treatment that is effective for reducing headache
pain intensity in CTTH.
Introduction
Headache disorders, including tension-type headache
(TTH) and migraine, are syndromes (symptoms with no
known cause). The symptom of pain in the head seems to
affect every aspect of a person’s well-being causing dis-
ability
1
and is a major public health problem because it costs
billions of dollars in treatment and lost productivity world-
wide.
2–5
Headache disorders account for up to 20% of all
work absences due to illness.
6
Chronic tension-type headache (CTTH) is defined as 15 or
more episodes of TTH per month. The prevalence of CTTH is
around 3%.
7
CTTH is notoriously difficult to treat and often
coexists with migraine, making a diagnosis difficult at times.
The first author’s PhD research (Kanji, G. 2013. The
Sensory Amplification of Pain: The Adrenaline Model of
Headache Causation. PhD diss., Massey Univ.), led to crea-
tion of a model of central sensitization, whose main focus is
on reduction in pain threshold through increased sympathetic
tone and increased pain threshold through reduced sympa-
thetic tone. Sympathetic tone is reduced by relaxation,
8
heat,
9
and regular exercise.
10
Prior research has found regular ex-
ercise and autogenic meditation to be helpful for headache
disorders,
11
with relaxation and regular exercise possibly
reducing sympathetic tone. Because heat reduces sympathetic
tone,
9
we decided to investigate whether regular sauna bath-
ing would improve symptoms in CTTH.
To identify relevant articles on the effects of sauna on chronic
pain, a literature search of Web of Science, EBSCO, and Ovid
Medline was performed by using ‘‘far-infrared sauna’’ OR
‘‘sauna’’ OR ‘‘thermal therapy.’’ The above search was com-
bined by using AND with ‘‘pain.’’ Articles were restricted to the
English language and human participants. Clinical trials of sauna
for chronic pain conditions were restricted to randomized con-
trolled trials (RCTs); however, because of the search yielded no
RCTs, prospective case series were included if there were more
1
Musculoskeletal Pain Specialist, Wellington Pain and Headache Clinic, Southern Cross Hospital, Wellington, New Zealand.
2
Department of Medicine, University of Otago Wellington, Wellington, New Zealand.
3
School of Communication and Journalism, Massey University, Wellington, New Zealand.
4
Biostatistical Services, University of Otago Wellington, Wellington, New Zealand.
5
Institute of Food, Nutrition and Human Health, Massey University, Wellington, New Zealand.
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 21, Number 2, 2015, pp. 103–109
ªMary Ann Liebert, Inc.
DOI: 10.1089/acm.2013.0466
103
than 10 participants. This search identified one RCT
12
and three
case series.
13–15
The RCT showed greater improvement in pain
score and depression in the sauna group, although these did not
reach statistical significance; it also showed a reduction in anger
scores, which was statistically significant. The treatment was
ratedverysatisfactoryby18(82%)ofthepatientswithchronic
pain in the sauna group. Overall, the three case series showed a
positive effect of regular sauna bathing on chronic pain. The
sauna was well tolerated by the participants, and no significant
adverse effects were observed.
Sauna may represent a novel treatment option for CTTH
and may appeal to many patients who prefer not to take
medications because of problems with tolerance and adverse
effects. The purpose of this study was to investigate the
efficacy of regular sauna bathing on reducing headache pain
intensity and duration.
Materials and Methods
Study design
This was a 12-week, parallel-group RCT. The control group
received education and self-directed soft tissue massage, while
the intervention group received education and self-directed soft
tissue massage and attended a sauna three times a week for 20
minutes for 8 weeks. The soft tissue massage prescribed to both
groups was based on acupressure massage techniques. This
was self-directed to be performed daily over tender muscles in
the neck region. Participants were given a handout on the
technique. Sauna cards were given to those attending saunas
associated with local public swimming pools in several loca-
tions within Wellington, New Zealand. Before participants
provided consent to enter into the study, they were given an
information sheet outlining the study design. The participants
were aware that there were two arms to the trial but unaware of
what the treatment arm of the trial consisted.
Participants
Volunteers were recruited from Wellington, New Zeal-
and, between September 2008 and March 2009 by adver-
tising in local newspapers. The study was carried out at
Southern Cross Hospital, a private hospital in Newtown,
Wellington. The Upper South A Regional Ethics Committee
approved the study. The trial was registered with the Aus-
tralian New Zealand Control Trial Registry (registration
number 12609000746235).
Inclusion criteria were age 20 to 70 years and CTTH,
defined by the International Headache Society classifica-
tion
16
as headaches present for more than 15 days per
month. The pain is typically bilateral, pressing or tightening
in quality, and of mild to moderate intensity, and it does not
worsen with routine physical activity. Mild nausea, photo-
phobia, or phonophobia may be present. Exclusion criteria
were a known cause of symptoms, such as acute sinusitis,
eyesight, head injury or ear problems, cancer, acute infec-
tions (including viral illness), previous spinal surgery, can-
cer, and pregnancy or intended pregnancy.
Study procedures
A randomization schedule was created from random-
number tables obtained from an investigator not involved
with the clinical trial. The allocation list was administered
by the principal investigator at the initial appointment once
patients met the criteria for CTTH.
Figure 1 shows the timeline for the study. Potential par-
ticipants for the trial were called and screened for eligibility.
All eligible participants were given a 4-week headache
diary. Participants kept a daily record of worst pain expe-
rienced that day and daily duration of headache in hours.
Once participants completed their 4-week diary, they were
seen at an initial consultation that lasted 30 minutes.
FIG. 1. Timeline for the study. F, fortnight in the study; F0, weeks 1 and 2; F1, weeks 3 and 4; F2, weeks 5 and 6; F3,
weeks 7 and 8; F4, weeks 9 and 10; F5, weeks 11 and 12.
104 KANJI ET AL.
Before the initial consultation, reception staff blinded
to the intervention administered a questionnaire to obtain
baseline data, including demographic information, numeri-
cal sleep disturbance score (0 =no sleep disturbance; 10 =
extreme sleep disturbance), Beck Depression Inventory
(BDI) score,
17
and Headache Disability Index (HDI)
score.
18
At the initial consultation (T
0
) a brief history and
examination were performed. Both groups were educated on
a model of headache causation and given instruction on self-
directed soft tissue massage. The intervention group was
given a sauna card and information on the safe use of sauna.
These participants were advised to attend the sauna for 20
minutes three times per week. Both groups received hand-
outs with the model of headache causation and instructions
on their respective treatments. Patients were advised to
continue with their usual medical care. The participants
were not told whether the sauna treatment was the control
arm of the trial; however, allocation to sauna treatment was
not masked.
Participants continued their allocated treatment for 8
weeks. At the second week a telephone follow-up was
performed to ensure compliance and assist with any diffi-
culties. At the end of 8 weeks, participants were seen at a
final consultation (T
1
). Before the final consultation, par-
ticipants completed the same questionnaire administered
prior to the initial consultation.
Outcome measures
The primary outcome measure in this study was the
change in the numeric pain rating scale (NPRS) for head-
ache intensity from the fortnight at baseline to the last
fortnight. The NPRS is an 11-point scale on which 0 =no
pain and 10 =worst pain imaginable. Secondary outcomes
were reductions in daily duration of headache measured
from the fortnight at baseline before the intervention and the
last fortnight. Depression as determined by the BDI II
questionnaire,
17
HDI score as determined using the HDI
questionnaire,
18
and sleep disturbance as measured by a
numeric rating scale were obtained at T
0
and T
1
. All mea-
surements were self-reported.
Sample size
Previous research
19
on headache found a mean value for
pain intensity on a visual analogue scale at presentation of 8
of 10 with a standard deviation of 1.5. To have 80% power,
at an avalue of 0.05 to detect a difference of 1.5 units
between two randomized groups, 17 participants had to be
randomly assigned to each of two groups, with a total of 34
participants for the study. We aimed at recruiting 40 par-
ticipants to allow for dropouts.
Statistical analysis
SAS software, version 9.3 (SAS Institute Inc., Cary,
NC), was used for the statistical analysis. Data were ana-
lyzed on a per protocol basis. All participants who un-
derwent random allocation were analyzed according to
the group assignment. Data entry was blinded to treatment
allocation. Data were analyzed by using average fort-
nightly NPRS and headache duration data immediately
before treatment and for the last fortnight. For all the
outcome variables, change from the baseline to the end of
the treatment period was calculated.
To investigate the main effects of treatment group and
time and their interaction, an analysis of the headache in-
tensity and duration using a mixed model analysis of vari-
ance was performed. The fixed effects were group and time
and their interaction. The random effect was the participant,
with a compound symmetry covariance structure for re-
peated measurements. Group main effects for change from
baseline in pain intensity and duration were estimated with a
contrast for the difference between control group and in-
tervention group in the mean change from baseline. The
difference between the sauna and control group in the final
measures for the dependent variables of sleep disturbance,
BDI scores, and HDI scores before and after the trial were
analyzed by using analysis of variance to explore differ-
ences between the groups, adjusting for the levels before
treatment. Histograms were examined to assess whether the
data were normally distributed. These showed that the data
were reasonably consistent with normal distribution.
Results
Figure 2 shows the flowchart for recruitment of partici-
pants for the trial. Ninety-four potential participants were
reviewed, and 47% were eligible for the study. Eligible
participants for this study began a baseline observation pe-
riod of 4 weeks, which was then followed by an intervention
period of 8 weeks (Fig. 1).
Table 1 shows the baseline characteristics of the 37 par-
ticipants who completed the initial diary in the first 4 weeks
FIG. 2. Flowchart for recruitment and participation. TTH,
tension-type headache.
EFFICACY OF REGULAR SAUNA BATHING FOR CHRONIC TENSION-TYPE HEADACHE 105
and were randomly assigned to a control or intervention
(sauna) group. There were no statistically significant dif-
ferences ( p<0.05) in mean age, headache intensity, head-
ache duration, number of headaches experienced per month,
sleep disturbance score, BDI score, or HDI score between
control or intervention group. Overall the mean (standard
deviation) age was 42.9 (13.3) years, and mean (standard
deviation) duration of headaches was 16.7 (13.5) years for
the 37 participants. Eight participants were taking tricyclic
antidepressants for their headaches: three participants in the
control group and five in the intervention group.
Six participants lost or did not complete their diary after
the 8 weeks: four in the control group and two in the in-
tervention group (Fig. 1). All participants with complete
data were analyzed according to their group allocation.
The mean headache intensity and the duration and number
of days headache was present in the control group and in-
tervention group over the trial period are shown in Table 2.
At all fortnightly time points (F0–F5 in Table 2), the mean
scores for all variables in the intervention group diminished
each fortnight. However, this was not observed within the
control group.
There were significant differences between times for the
sauna group for headache intensity (F=8.54; df =4, 117;
p£0.0001) and duration (F=5.10; df =4, 118; p=0.0008)
(Table 2). Headache intensity was significantly different from
baseline at F2 ( p=0.034), F3 (p =0.0002), F4 ( p<0.0001),
and F5 ( p<0.0001) and between F2 and F4 (p=0.017) and
F5 ( p=0.013). Headache duration was significantly different
from baseline at F3 (p=0.003), F4 ( p=0.0001), and F5
(p=0.0008) and between F2 and F4 (p=0.032). There were
no significant differences between times for the control group
for headache intensity (F=0.95; df =4,117; p=0.44) or du-
ration (F=0.76; df =4, 118; p=0.55).
For pain intensity, the interaction of group times time was
significant (F=2.95; df =4 117; p=0.023). There were
significant differences between the sauna and control groups
at F3, F4, and F5 (Table 3). There was a significant differ-
ence in mean change of 1.27 points (95% confidence in-
terval [CI], 0.48–2.07; F=10.17; df =1 117; p=0.002) for
headache pain intensity.
For headache duration, the interaction of group with time
was not significant (F=1.66; df =4119; p=0.16). The
headache duration was significantly different between the
sauna and control groups at F3 (Table 4) with a significant
difference in mean change of 2.10 points (95% CI, 0.27–
3.93; F=5.16; df =1, 117; p=0.025).
There was no statistically significant difference in the
change in sleep disturbance in the sauna group compared
with the control group (0.3; 95% CI, -1.8 to 2.5; F=0.09;
df =1, 29; p=0.77). There were no significant differences
between times for the sauna group (F=1.89; df =1, 29;
p=0.18) or the control group (F=0.61; df =1, 29; p=0.44).
There was no statistically significant difference in the
change in BDI score in the sauna group compared with the
control group (1.8; 95% CI, -3.4 to 6.9; F=0.48; df =1, 30;
p=0.49). There was a significant difference between times
for the sauna group (F=10.20; df =1, 30; p=0.004), but not
for the control group (F=3.19; df =1, 30; p=0.085).
There was a statistically significant difference in the
change in HDI score in the sauna group compared with the
control group (10.8; 95% CI, -7.0% to 28.5%; F=1.55;
Table 1. Baseline Characteristics for the Control
Group and Intervention Group Participants
Characteristic
Control
group
(n=20)
Sauna
group
(n=17)
Mean age (yr) 44.3 (10.5) 40.7 (16.8)
Mean duration of headaches (yr) 17.3 (13.3) 15.7 (13.3)
Mean days of headache
per month
23.6 (8.3) 23.6 (8.3)
Women, n(%) 17 (85.0) 12 (70.6)
Men, n(%) 3 (15.0) 5 (29.4)
Taking preventative
medication, n(%)
3 (15) 5 (29)
Mean headache intensity (NPRS
score out of 10)
3.5 (1.8) 4.3 (1.7)
Mean duration headache (hr/d) 6.6 (5.5) 8.3 (5.5)
Sleep disturbance 3.2 (2.2) 3.3 (2.5)
BDI score 11.1 (9.3) 13.0 (10.2)
HDI score 48.7 (22.1) 48.0 (27.9)
Mean values are expressed with standard deviations in parenthe-
ses. To test for differences between groups at baseline, independent
sample t-test was performed. There were no statistically significant
differences ( p<0.05) between groups.
NPRS, numerical pain rating scale; BDI, Beck Depression
Inventory; HDI, Headache Disability Index.
Table 2. Fortnightly Mean Measures of Headache Intensity, Headache Duration,
and Number of Days Headache Present
Outcome measures per group F0 F1 F2 F3 F4 F5
Headache intensity (NPRS)
Control 3.5 (1.8) 3.5 (2.0) 3.4 (1.6) 3.3 (1.9) 3.0 (1.6) 3.1 (1.9)
Intervention 4.5 (1.7) 4.3 (1.7) 3.5 (1.7) 2.8 (1.5) 2.5 (1.6) 2.6 (1.9)
Headache duration (hr/d)
Control 7.0 (5.3) 6.6 (5.5) 6.2 (5.1) 6.1 (5.5) 5.6 (4.6) 6.1 (4.8)
Intervention 8.4 (5.3) 8.3 (5.5) 7.4 (5.5) 6.2 (5.5) 5.3 (5.3) 5.7 (5.9)
Days with headache present
Control 11.7 (2.4) 11.1 (3.0) 11.6 (3.0) 11.7 (3.4) 10.7 (4.2) 10.7 (4.2)
Intervention 12.9 (2.0) 12.8 (1.7) 11.2 (4.2) 10.6 (3.7) 9.9 (4.4) 9.6 (4.8)
Data are expressed as mean (standard deviation). Fortnights are designated as F0, F1, F2, F3, F4, and F5, with F1 representing the initial
score (weeks 3 and 4) and F5 representing the final score (weeks 11 and 12). Data were taken from the daily headache diary.
F, fortnight.
106 KANJI ET AL.
df =1, 23; p=0.22). There was a significant difference be-
tween times for the sauna group (F=15.85; df =1, 23;
p=0.0006), but not for the control group (F=1.85; df =1,
23; p =0.19).
Adverse effects
Potential adverse effects of attending a sauna include
fainting and feelings of claustrophobia. All participants were
contacted 2 weeks after entering the treatment phase to
enquire about adverse effects and whether they experienced
any difficulties or problems with respect to the sauna or soft
tissue massage. Participants were also asked about adverse
effects at the final consultation. No participants in either
group reported adverse effects.
Discussion
This RCT appears to be the first study to use sauna as an
intervention for CTTH. Headache intensity decreased 44%
in the intervention group. Previous treatment trials on CTTH
have shown a reduction in headache intensity ranging from
13% for mitrazapine
20
to 83% for autogenic relaxation.
21
The highest percentage reduction by a medication has been
59% with the combination of amitriptyline and tizanidine.
22
The 44% reduction in headache intensity by sauna is a result
similar to those seen with several medications studied for
CTTH, including sodium valproate (40% reduction),
23
am-
itriptyline (33% reduction),
24
tizanidine (approximately
50% reduction),
25,26
and desipramine and fluoxetine (33%
reduction).
27
Medications that showed a lesser reduction in
headache intensity include sertraline (20%),
24
mitrazapine
(13%),
20
and alprazolam (18%).
21
The sauna group showed
a favorable reduction in headache intensity when compared
with botulinum toxin (23% and 16% reductions),
28,29
acu-
puncture (33% reduction),
11
and physical therapy (33% re-
duction).
11
Relaxation therapy produced a 42% reduction in
headache intensity,
11
which is also similar to the reduction
achieved with the use of sauna.
This trial ran for 12 weeks; the treatment protocol (at-
tending the sauna for 20 minutes three times a week) lasted
8 weeks. Clinically and statistically significant changes in
headache intensity were present by week 6 of the inter-
vention. Preventive medication seems to take a similar
period of time to reach effectiveness, as shown by Holroyd
and colleagues.
30
Those researchers found that 20 of 53
(38%) patients taking amitriptyline, 34 of 53 (64%) taking
amitriptyline and receiving stress management, 17 of 49
(35%) receiving stress management, and 14 of 48 (29%)
taking placebo medication achieved a greater than 50%
reduction in pain intensity after 1 month. A trial of tiza-
nidine showed reduction in headache intensity after 6
weeks of treatment.
26
The changes in headache intensity may represent a re-
gression to the mean as people may be motivated to join a
clinical trial when the problem is at its worst, making
spontaneous improvement more likely or perhaps reflect
the natural history of a condition. The sauna group had had
headache for an average of 14.4 years, and the control
group had experienced headache for an average of 18.9
years. Thus, both groups had experienced headache for
several years, and regression to the mean or natural history
of improvement is unlikely to explain the effect observed
in this trial.
Sleep disturbance and depression are comorbid with
headache disorders and were secondary outcome measures
in this study. Neither the control nor the intervention group
showed statistically significant changes in sleep disturbance
or depression.
Headache disability measures the limitations of symp-
toms on a patient’s activities. The changes in headache
disability measured by the HDI favored the intervention
group; the HDI score decreased 32% in the control group
and by 40% in the intervention group. An overall reduction
of 29 points is considered a statistically significant reduction
in HDI score that can be attributed to treatment; one par-
ticipant in the control group and three participants in the
intervention group achieved a decrease of 29 points. The
reduction in HDI score in both groups may be attributed to
being involved in a clinical trial. In addition, the education
and advice on stress management may have given both
groups some insight into their symptoms and a measure of
control that may have contributed to improving disability
associated with headache.
Table 3. Difference from Baseline in Headache
Intensity at Different Time Points Between
the Control Group and the Sauna Group
Time
Difference in mean
change (95% CI) p-Value
F2 0.88 ( -0.14 to 1.91) 0.089
F3 1.45 (0.43–2.48) 0.006
a
F4 1.31 (0.29–2.32) 0.012
a
F5 1.45 (0.45–2.45) 0.005
a
Analysis was by mixed linear model analysis with fixed effects
for randomized group, time, and their interaction, and a random
effect was the participant with a compound symmetry covariance
structure for repeated measurements. Group main effects for change
from baseline were with a contrast for the difference between
control group and intervention group in the mean change from
baseline. Degrees of freedom (df) for F2, F3, F4 and F5 is 1,119.
a
p<0.05 indicates statistically significant difference.
CI, confidence interval; F2, weeks 5 and 6 of the trial; F3, weeks
7 and 8 of the trial; F4, weeks 9 and 10 of the trial, F5, weeks 11 and
12 of the trial.
Table 4. Difference from Baseline in Duration
of Headache at Different Time Points Between
the Control Group and the Sauna Group
Time
Difference in mean
change (95% CI) p-Value
F2 1.22 ( -1.11 to 3.56) 0.30
F3 2.60 (0.26–4.93) 0.030
a
F4 2.25 ( -0.10 to 4.61) 0.061
F5 2.34 ( -0.02 to 4.69) 0.052
Analysis was by mixed linear model analysis with fixed effects
for randomized group, time, and their interaction, and a random
effect was the participant with a compound symmetry covariance
structure for repeated measurements. Group main effects for change
from baseline were with a contrast for the difference between
control group and intervention group in the mean change from
baseline. Degrees of freedom (df) for F2, F3, F4 and F5 is 1,121.
a
p<0.05 indicates statistically significant difference.
EFFICACY OF REGULAR SAUNA BATHING FOR CHRONIC TENSION-TYPE HEADACHE 107
The representativeness of the cohort studied and the
effects of participation in a randomized trial will affect the
generalizability of the trial results. Biases in this trial in-
cluded participants wishing to try a nondrug treatment for
CTTH and participants willing to attend the sauna for three
times a week for 8 weeks rather than take a tablet once or
twice a day. Attending the sauna requires substantially
more time and motivation than taking tablets, and the
population of patients with CTTH may not have the time to
carry out sauna treatment, thereby excluding them from
this treatment.
This RCT was designed to examine a noninvasive self-
treatment requiring minimal medical supervision and in this
aim it was successful. A limitation of this clinical trial was
lack of quantification of sauna attendance. Sauna attendance
was enquired about during the telephone follow-up con-
ducted at 2 weeks to address any difficulties in attending.
During discussion with participants in the final assessment
consultation, participants in the sauna group readily vo-
lunteered their experiences of attending the sauna, describ-
ing the sauna facilities at the different venues they attended,
the experience of attending a sauna, and some of the effects
they experienced (such as profound relaxation or feeling
uncomfortably hot to begin with). It was apparent that most
participants in the sauna group tried the intervention, but
how often and for how long are not known. For future
studies, an attendance record for the sauna could be re-
corded with the headache diary or an attendance register at
the sauna facility.
The information provided to the participants in this trial
did not disclose which group was the intervention group and
which the control group. At the initial assessment, several
participants questioned whether the sauna was the control or
intervention. From responses in the sauna group many
considered this an unlikely form of intervention in a clinical
trial run by a medical doctor (principal investigator). Al-
though they were not blind to the intervention they were to
receive, they were blind to whether it was the active treat-
ment of the trial. If participants in the sauna group were
advised that they were in the active treatment group, their
expectations may have been heightened, thereby increasing
the placebo effect.
After their education with regard to headaches, both the
sauna group and the control group may have sought to re-
duce their stressors or started to exercise regularly in the
knowledge that exercise may reduce headache. Participants
in the sauna group may have gone for a swim as the com-
plimentary entry card to the pools also gave entry to the
swimming pool (the sauna is situated next to the pool but
within the same entrance). Therefore, participants may have
performed more regular exercise than the control group.
Social factors of talking to receptionists at the pool and other
occupants of the swimming pool and or sauna may have a
beneficial effect on participants. The experience of taking
time out of their normal routine to attend the sauna may have
created a feeling that they were doing something positive
about their health, creating a placebo response in itself.
In conclusion, this randomized control trial examined the
efficacy of heat in the form of sauna in patients with CTTH.
Sauna produced a 44% reduction in headache intensity
within 6 weeks of treatment. These results show that regular
sauna bathing may provide a promising nonpharmaceutical,
self-directed management option that requires minimal
medical input.
Author Disclosure Statement
No competing financial interests exist.
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Address correspondence to:
Rachel Page, PhD
Institute of Food, Nutrition
and Human Health
Massey University
Private Bag 76,
Wellington 6140
New Zealand
E-mail: R.A.Page@massey.ac.nz
EFFICACY OF REGULAR SAUNA BATHING FOR CHRONIC TENSION-TYPE HEADACHE 109
... i. Nine out of the 35 studies were graded as having good methodological quality following assessment (Aguirrezabal et al., 2019;Alvarez-Melcon et al., 2018;John et al., 2007;Kanji et al., 2015;Lin & Wang, 2015;Madsen et al., 2018;Seng et al., 2019;E. I. Söderberg et al., 2011;Varkey et al., 2011); ii. ...
... Majority of the participants were females (82%) mainly having migraine, TTH and chronic headache. Twenty-three out of the 35 studies reported on migraine (Aguirrezabal et al., 2019;Bakhshani et al., 2015;Bhombal et al., 2014;Bromberg et al., 2012;Calhoun & Ford, 2007;D'Souza et al., 2008;Devineni & Blanchard, 2005;Dittrich et al., 2008;John et al., 2007;Khazraee et al., 2018;Kleiboer et al., 2014;Lockett & Campbell, 1992;Martin et al., 2014;McGrady et al., 1994;Merelle et al., 2008;Narin et al., 2003;Peres et (Holroyd et al., 2001), Tai-Chi (Abbott et al., 2007), sauna (Kanji et al., 2015) and yoga (John et al., 2007). Other hands-off interventions tested in the studies are selfadministered; strength training (Madsen et al., 2018) and stretching exercises (Lee & Lee, 2019;Lin & Wang, 2015). ...
... Other hands-off interventions tested in the studies are selfadministered; strength training (Madsen et al., 2018) and stretching exercises (Lee & Lee, 2019;Lin & Wang, 2015). Kanji et al., 2015;Khazraee et al., 2018;Kleiboer et al., 2014;Lee & Lee, 2019;Merelle et al., 2008;Narin et al., 2003;Peres et al., 2019;Rothrock et al., 2006;Seng et al., 2019;Sertel et al., 2017;Slavin-Spenny et al., 2013;Sorbi et al., 2015;Tavallaei et al., 2018) and three (Calhoun & Ford, 2007;Kanji et al., 2015;E. I. Söderberg et al., 2011) RCTs reported on pain intensity, QoL, disability and sleep quality, respectively. ...
Article
A number of hands-off therapies have been widely reported and are used in the management of headache. This systematic review and meta-analysis aimed to assess evidence supporting these therapies on selected headache outcomes. A systematic literature search for randomized clinical trials reporting on the effects of hands-off therapies for headache was performed in two electronic databases; PubMed and Web of Science (PROSPERO: CRD42018093559). Risk of bias was assessed using the Cochrane risk of bias tool. Meta-analysis was performed using Review Manager v5.4. Thirty-five studies, including 3,403 patients with migraine, tension-type or chronic headaches were included in the review. Methodological quality of the studies ranged from poor to good. Result-synthesis revealed moderate evidence for aerobic exercises, relaxation training and pain education for reducing pain intensity and disability. Other hands-off interventions were either weak or limited in evidence. Meta-analysis of 22 studies indicated that the effect of hands-off therapies significantly differed from one another for pain intensity, disability and quality of life (p < 0.05). Relaxation training, aerobic and active/stretching exercises had significant effect on pain intensity and disability (p < 0.05). To conclude, few hands-off therapies were effective on selected headache outcomes. Evidence to support other hands-off therapies is limited by paucity of studies.
... Thermal therapy and sauna affect lipid profile and quality of life in patients with type 2 diabetes mellitus and obesity [37][38][39]. Regular sauna bathing has been considered effective in the management of tension headaches [40]. Sauna-based detoxification therapy reduced the chronic symptoms related to the chemical exposures of methamphetamine and also improved the quality of life [41]. ...
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Proper and regular sweating plays a significant thermoregulatory role. It is a common perception that, sweating has other important homeostatic functions such as clearance of excessive micronutrients, waste products of metabolic processes, and toxins from the body, which helps to maintain human good health. In addition, sweating, thermotherapy, and sauna are commonly used to treat various diseases such as cardiovascular, respiratory and joint diseases. In traditional Persian medicine (PM) textbooks, sweating is considered a preventive care and treatment strategy as well. In this study, we aim to explain the beneficial effects of sweating in human health and its role in the management of various diseases, as well as introducing the therapeutic applications of some diaphoretic plants from the viewpoint of PM. We reviewed the most famous PM textbooks such as Kamil al-Sinaa al-Tibbiya, Al-Qānūn fī al-Tibb, Zakhireye Kharazmshahi, Kholasat al-Hikmat, Exir-e-Azam, and Hifzos-sihhat-e Naseri. Also, current evidence was searched in PubMed, Web of Science, Scopus, and other relevant databases related to the topic. The results of this study revealed that PM scientists believed proper sweating removes waste products and maintains the body’s health, thus, any disturbances in the excretion of these waste products can cause diseases. They recommended the induction of sweating through hot and dry baths, sun bath, sand bath and also the use of diaphoretic herbs for the management of various diseases. Therefore, further researches are recommended to evaluate the effectiveness of these diaphoretic plants. [GMJ.2020;9:e2003]
... The results showed a significant improvement of the applied parameters as well as the reduction of pain in the case groups. In terms of pain duration, sleep deprivation and onset of depression, no significant changes were recorded and there were no statistically significant changes between the two groups [21]. At the same time, the sauna also had beneficial effects on appetite (the effects were recorded by increasing caloric intake and plasma ghrelin concentration) [22]. ...
Article
ound: Regular sauna exposure has been shown to positively influence clinical symptoms in various pathologies. The purpose of this review is to present the evidence accumulated so far in order to evaluate the efficiency, effects, benefits and risks of sauna therapy in the field of various pathologies that require medical rehabilitation. Methods: A literature search was conducted on Publons and PubMed databases from January 2000 onwards. The studies selected for this review included research in humans undergoing repeated sauna sessions with at least one reported health outcome. Results: Constant application of sauna therapy has visible effecta on improving cardiac activity, endothelial function, myocardial perfusion, ventricular arrhythmia. Sauna treatment is a safe procedure for pa-tients with cardiovascular, respiratory, musculo-skeletal pathologies, with no notable side-effects. Conclusions: Sauna therapy has proved its effectiveness in medical rehabilitation treatment starting from the musculoskeletal system and skin to the nervous system. In addition, it brings a significant improvement in the quality of life of patients.
... The results showed a significant improvement of the applied parameters as well as the reduction of pain in the case groups. In terms of pain duration, sleep deprivation and onset of depression, no significant changes were recorded and there were no statistically significant changes between the two groups [21]. At the same time, the sauna also had beneficial effects on appetite (the effects were recorded by increasing caloric intake and plasma ghrelin concentration) [22]. ...
Article
Background: Regular sauna exposure has been shown to positively influence clinical symptoms in various pathologies. The purpose of this review is to present the evidence accumulated so far in order to evaluate the efficiency, effects, benefits and risks of sauna therapy in the field of various pathologies that require medical rehabilitation. Methods: A literature search was conducted on Publons and PubMed databases from January 2000 onwards. The studies selected for this review included research in humans undergoing repeated sauna sessions with at least one reported health outcome. Results: Constant application of sauna therapy has visible effecta on improving cardiac activity, endothelial function, myocardial perfusion, ventricular arrhythmia. Sauna treatment is a safe proce-dure for patients with cardiovascular, respiratory, musculo-skeletal pathologies, with no notable side-effects. Conclusions: Sauna therapy has proved its effectiveness in medical rehabilitation treatment starting from the musculoskeletal system and skin to the nervous system. In addition, it brings a significant improvement in the quality of life of patients. Keywords: sauna bathing; dry sauna; regular sauna exposure; clinical applications sauna; bio-logical effects sauna; quality of life
... Repeated sauna therapy has also been proven to be an effective intervention for improving mental health in patients with Chronic Heart Failure [41]. Other studies have found significant pain relief and improvement in subjective wellness after the use of sauna therapy [42,43]. ...
... Additionally, a previous study concluded that repeated increase in blood flow caused by heat enhances endothelium-mediated vasodilator function among healthy subjects [8] . SB may also mitigate nonvascular conditions such as obstructive lung disease [9] , the effects of low levels of physical activity [10] , dementia [11] , headaches [12] , mild depression [13] , and adverse skin conditions [14] . Furthermore, existing studies also focused on the biochemical markers including insulin sensitivity [15] , , lower limbs (f), and buttocks (g) is supplied by the common carotid artery (CCA), subclavian artery II (SA II), intercostal arteries (IAs), superior and inferior epigastric artery (SEA and IEA), lumbar artery (LA), femoral artery (FA), and internal iliac artery II (IIA II), respectively. ...
Article
Objective : Sauna bathing (SB) is an important strategy in cardiovascular protection, but there is no mathematical explanation for the reallocation of blood circulation during heat-induced superficial vasodilation. We sought to reveal such reallocation via a simulated hemodynamic model. Methods : A closed-loop cardiovascular model with a series of electrical parameters was constructed. The body surface was divided into seven blocks and each block was modeled by a lumped resistance. These resistances were adjusted to increase skin blood flow (SBF), with the aim of reflecting heat-induced vasodilation during SB. Finally, the blood pressure was compared before and after SB, and the blood flow inside the aorta and visceral arteries were also analyzed. Results : With increasing SBF in this model, the systolic, diastolic, and mean blood pressure in the arterial trunk decreased by 13–29, 18–36, and 19–37 mmHg, respectively. Despite the increase in the peak and mean blood flow in the arterial trunk, the diastolic blood flow reversal in the thoracic and abdominal aortas increased significantly. Nevertheless, the blood supply to the heart, liver, stomach, spleen, kidney, and intestine decreased by at least 25%. Moreover, the pulmonary blood flow increased significantly. Conclusion : Simulated heat-induced cutaneous vasodilation in this model lowers blood pressure, induces visceral ischemia, and promotes pulmonary circulation, suggesting that the present closed-loop model may be able to describe the effect of sauna bathing on blood circulation. However, the increase of retrograde flow in the aortas found in this model deserves further examination.
... Sauna bathing may reduce the risk of respiratory diseases, treatment of chronic headache and skin diseases like psoriasis and urticaria [10,11]. The high temperature of the sauna bath also helps to eradicate dermatophytes [10]. ...
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Introduction: Sauna bathing as a health-promoting activity has been known to mankind for millennia. Sauna session, which consists of alternate overheating and then rapidly cooling the body, has a beneficial effect on the health of the body confirmed by scientific research. In the last few decades, sauna bathing has become more available due to the growing market of recreational services such as water parks and sauna parks. Regular use of sauna bathing reduces the risk of cardiovascular diseases, musculoskeletal disorders, mental stress, accelerates the process of regeneration after physical exertion, as well as increases resistance to the harmful effects of certain environmental factors. Despite the health benefits known for many years, the physiological mechanisms occurring in the body during sauna sessions still remain unknown. Sauna bathing treatments can be an effective complement to the process of treatment and rehabilitation of patients with cardiovascular diseases, musculoskeletal diseases, respiratory tract diseases, skin diseases and many others. Material and methods: A literature analysis on sauna bathing was carried out within the Pubmed and Google scholar platforms. The following keywords were used in search: sauna bathing, infrared sauna, cardiovascular diseases. Purpose of the work: The aim of the following analysis is to present a historical outline of the use of sauna bathing, the health aspect, risks and the assumptions and indicating an important need for further research into the effects of sauna bathing on the body.
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Passive heat therapy is characterized by exposure to a high environmental temperature for a brief period. There are several types of passive heat therapy which include hot tubs, Waon therapy, hydrotherapy, sanarium, steam baths, infrared saunas and Finnish saunas. The most commonly used and widely studied till date are the Finnish saunas, which are characterized by high temperatures (ranging from 80–100°C) and dry air with relative humidity varying from 10–20%. The goal of this review is to provide a summary of the current evidence on the impact of passive heat therapies particularly Finnish saunas on various health outcomes, while acknowledging the potential of these therapies to contribute to the extension of healthspan, based on their demonstrated health benefits and disease prevention capabilities. The Finnish saunas have the most consistent and robust evidence regarding health benefits and they have been shown to decrease the risk of health outcomes such as hypertension, cardiovascular disease, thromboembolism, dementia, and respiratory conditions; may improve the severity of musculoskeletal disorders, COVID-19, headache and flu, while also improving mental well-being, sleep, and longevity. Finnish saunas may also augment the beneficial effects of other protective lifestyle factors such as physical activity. The beneficial effects of passive heat therapies may be linked to their anti-inflammatory, cytoprotective and anti-oxidant properties and synergistic effects on neuroendocrine, circulatory, cardiovascular and immune function. Passive heat therapies, notably Finnish saunas, are emerging as potentially powerful and holistic strategies to promoting health and extending the healthspan in all populations.
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Background Many individuals who use the sauna at a temperature of 120°C of higher are not aware of the negative consequences of extreme thermal stress. Despite extensive research into sauna use, the impact of extreme thermal stress on the physiological and psychological characteristics of sauna users have not been examined to date. Aim The aim was to determine the effect of 20 min sauna sessions with a temperature of 80°C and 120°C on the physiological and psychological characteristics of women who sporadically visit the sauna. Methods The study was conducted on 22 full-time female university students. Physical activity (PA) levels were evaluated with the Polish short version of the International Physical Activity Questionnaire (IPAQ). Anthropometric characteristics were measured before the first sauna session by the InBody270 body composition analyzer. Physiological parameters, including heart, energy expenditure, physical effort, and blood pressure (systolic blood pressure – SBP, and diastolic blood pressure – DBP), were assessed indirectly using Polar V800 heart rate monitors and the Omron M6 Comfort blood pressure monitor. The participants’ wellbeing was assessed with the Profile of Mood States (POMS) questionnaire. The presence of significant correlations between heat exhaustion and heat stress variables and syncope during the second sauna session was examined with the use of classification and regression trees (CRT) and the cross-validation technique. Results Twenty-minute sauna sessions with a temperature of 80°C and 120°C induced a significant (p < 0.001) decrease in the values of SBP (excluding the temperature of 120°C), DBP, and body mass, as well as a significant increase in HR and forehead temperature. Exposure to a temperature of 80°C led to a significant (p < 0.001) increase in vigor with a simultaneous decrease in tension, depression, anger, fatigue, and confusion. In turn, sauna bathing at a temperature of 120°C had an opposite effect on the above mood parameters. Vomiting and confusion were the main predictors of syncope that occurred in some of the surveyed women. Conclusion Excessive air temperature can induce symptoms characteristic of heat exhaustion and heat stress nausea, heavy sweating, fast weak or strong HR, high body temperature, and confusion. Therefore, sauna bathing at a temperature of 80°C can be recommended to women who sporadically use the sauna, whereas exposure to a temperature of 120°C is not advised in this group of sauna users. The present findings provide highly valuable inputs for managing wellness and SPA centers.
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Background and aim Low socioeconomic status (SES) and frequent sauna bathing are associated with increased and decreased risk of all-cause mortality, respectively. Whether there is an interplay between SES, sauna bathing and all-cause mortality is not known. We aimed to evaluate the separate and joint associations of SES and frequency of sauna bathing (FSB) with all-cause mortality risk in a prospective cohort study. Methods We employed the Kuopio Ischaemic Heart Disease Study cohort comprising of 2575 men aged 42–61 years at study entry. Self-reported SES and sauna bathing habits were assessed at baseline. Socioeconomic status was categorized as low and high (median cutoff) and FSB as low and high (defined as ≤2 and 3–7 sessions/week, respectively). Results During a median follow-up of 27.8 years, 1618 deaths occurred. Comparing low vs high SES, the multivariable-adjusted HR (95 % CI) for all-cause mortality was 1.31 (1.18–1.45). Comparing high vs low FSB, the multivariable-adjusted HR (95 % CI) for all-cause mortality was 0.86 (0.76–0.97). Compared with high SES-low FSB, low SES-low FSB was associated with an increased risk of all-cause mortality 1.35 (1.20–1.51), without significant evidence of an association for low SES-high FSB and all-cause mortality risk 1.07 (0.89–1.29). Positive additive and multiplicative interactions were found between SES and FSB. Conclusions There is an interplay between SES, sauna bathing and all-cause mortality in a general Finnish male population. Frequent sauna baths may offset the increased overall mortality risk due to low SES.
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Headache and stress may co-exist as cause or effect. This study was designed to co-relate chronic tension headache with blood cortisol level and its modulation by autogenic relaxation therapy. Randomized single blind parallel design prospective study carried out in a total of 380 patients of chronic tension headache, divided into two groups. Group 1 (n=190) patients received 8 lessons and practical demonstration of spiritual based meditation, known as Rajyoga meditation for relaxation therapy in addition to routine medical treatment (tab alprazolam 0.25 mg twice a day). Group 2 (n=190) patients received tablet alprazolam 0.25 mg twice a day but no relaxation therapy in the form of meditation. They were followed up for three months. Effect parameters studied were severity, frequency and duration of headache. Plasma cortisol level was measured before and 8 weeks after the treatment, in all patients.
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Patients with chronic tension- type headache (CTTH) are the most difficult to treat. Tricyclic antidepressants are the first-line therapeutic agents, but their anticholinergic side effects limit their usage. Selective serotonin reuptake inhibitors (SSRI) with fewer side effects than tricyclic antidepressants have also been used in treatment of CTTH, but the results are conflicting. In this study, prophylactic action of sertraline in treatment of nondepressed patients with CTTH was investigated and compared with amitriptyline in a prospective, randomized, open label, parallel-group study. A 4-week baseline period was followed by a 12-week treatment period with either 50 mg sertraline (n=41 patients) or 25 mg amitriptyline (n=44 patients). Efficacies of treatments were determined by using a headache diary, in which patients recorded the occurrence, number, intensity and duration of headaches in days, analgesic drug consumption and any adverse events. Both drugs reduced headache symptoms and analgesic drug consumption at the first, second and third months of treatment compared to baseline values. There was significant superiority of amitriptyline in the headache symptoms and drug consumption reductions versus sertraline at the second and third months of treatment. Side effects were more favorable in the sertraline-treated patients, but dropouts were similar in both groups. These results suggest that both drugs were effective in the treatment of non-depressed patients with CTTH, but in comparison between groups, amitriptyline was more effective than sertraline.
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To study the effects of infrared (IR) Sauna, a form of total-body hyperthermia in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients were treated for a 4-week period with a series of eight IR treatments. Seventeen RA patients and 17 AS patients were studied. IR was well tolerated, and no adverse effects were reported, no exacerbation of disease. Pain and stiffness decreased clinically, and improvements were statistically significant (p < 0.05 and p < 0.001 in RA and AS patients, respectively) during an IR session. Fatigue also decreased. Both RA and AS patients felt comfortable on average during and especially after treatment. In the RA and AS patients, pain, stiffness, and fatigue also showed clinical improvements during the 4-week treatment period, but these did not reach statistical significance. No relevant changes in disease activity scores were found, indicating no exacerbation of disease activity. In conclusion, infrared treatment has statistically significant short-term beneficial effects and clinically relevant period effects during treatment in RA and AS patients without enhancing disease activity. IR has good tolerability and no adverse effects.
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The aim was to study the extent and type of health service utilisation, medication habits, and sickness absence due to the primary headaches. This was a cross sectional epidemiological survey of headache disorders in a general population. Headache was diagnosed according to a structured interview and a neurological examination using the criteria of the International Headache Society. A random sample of 25-64 year-old individuals was drawn from the Danish National Central Person Registry. All subjects were living in the Copenhagen County. 740 subjects participated (76% of the sample); 119 had migraine and 578 had tension type headache. Among subjects with migraine 56% had, at some time, consulted their general practitioner because of the migraine. The corresponding percentage among subjects with tension type headache was 16. One or more specialists had been consulted by 16% of migraine sufferers and by 4% of subjects with tension type headache. The consultation rates of chiropractors and physiotherapists were 5-8%. Hospital admissions and supplementary laboratory investigations due to headache were rare (< 3%). Half of the migraine sufferers and 83% of subjects with tension type headache in the previous year had managed with at least one type of drug in the current year. Acetylsalicylic acid preparations and paracetamol were the most commonly used analgesics. Prophylaxis of migraine was used by 7%. In the preceding year 43% of employed migraine sufferers and 12% of employed subjects with tension type headache had missed one or more days of work because of headache. Most common was 1-7 days off work. The total loss of workdays per year due to migraine in the general population was estimated at 270 days per 1000 persons. For tension type headache the corresponding figure was 820. Women were more likely to consult a practitioner than men, whereas no significant sex difference emerged as regards absenteeism from work. The impact of the headache disorders on work performance in the general population is substantial, and the disorders merit increased attention.
Article
Context.— Tension-type headache is a highly prevalent condition. Because few population-based studies have been performed, little is known about its epidemiology.Objectives.— To estimate the 1-year period prevalence of episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) in a population-based study; to describe differences in 1-year period prevalence by sex, age, education, and race; and to describe attack frequency and headache pain intensity.Design.— Telephone survey conducted 1993 to 1994.Setting.— Baltimore County, Maryland.Participants.— A total of 13345 subjects from the community.Main Outcome Measures.— Percentage of respondents with diagnoses of headache using International Headache Society criteria. Workdays lost and reduced effectiveness at work, home, and school because of headache, based on self-report.Results.— The overall prevalence of ETTH in the past year was 38.3%. Women had a higher 1-year ETTH prevalence than men in all age, race, and education groups, with an overall prevalence ratio of 1.16. Prevalence peaked in the 30- to 39-year-old age group in both men (42.3%) and women (46.9%). Whites had a higher 1-year prevalence than African Americans in men (40.1% vs. 22.8%) and women (46.8% vs 30.9%). Prevalence increased with increasing educational levels in both sexes, reaching a peak in subjects with graduate school educations of 48.5% for men and 48.9% for women. The 1-year period prevalence of CTTH was 2.2%; prevalence was higher in women and declined with increasing education. Of subjects with ETTH, 8.3% reported lost workdays because of their headaches, while 43.6% reported decreased effectiveness at work, home, or school. Subjects with CTTH reported more lost workdays (mean of 27.4 days vs 8.9 days for those reporting lost workdays) and reduced-effectiveness days (mean of 20.4 vs 5.0 days for those reporting reduced effectiveness) compared with subjects with ETTH.Conclusions.— Episodic tension-type headache is a highly prevalent condition with a significant functional impact at work, home, and school. Chronic tension-type headache is much less prevalent than ETTH; despite its greater individual impact, CTTH has a smaller societal impact than ETTH.
Article
Amitriptyline, which is a noradrenaline reuptake and 5-HT reuptake inhibitor, has an established role in the management of chronic tension-type headaches. In a single-blind study, patients with chronic tension-type headache were randomized to either fluoxetine 20 mg (a selective 5-HT reuptake inhibitor) or desipramine 75 mg (a selective noradrenaline reuptake inhibitor) and followed for 12 weeks to compare the effectiveness of the two drugs in improving headache, and to assess whether pain control is related to changes in depression. Patients were evaluated at weekly intervals on an analog pain-rating scale and at 4-weekly intervals on the Montgomery and Asberg Depression Rating Scale (MADRS), the MOS general health status questionnaire (SF36), the Hospital Anxiety and Depression Scale (HADS), and a side effects checklist. Eighteen patients were randomized to take fluoxetine and 19 to take desipramine. Of the 25 patients who completed the trial, 12 were on fluoxetine and 13 were on desipramine. There was no significant difference between the two groups at baseline nor in change of pain; reduction in use of analgesic medication; nor change in the HADS, MADRS, or SF36 scores at 12 weeks, but 72% of patients who completed the study improved, and this improvement almost exactly mirrored the improvement on the MADRS. The results from this trial are compatible with the notion that the beneficial effect of antidepressants in chronic tension-type headache is indirect, mediated by an effect on depression, and not more,dependent on serotonin reuptake inhibition than noradrenaline reuptake inhibition.
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To ascertain how effective the Beck Depression Inventory for Primary Care (BDI-PC) was in screening for DSM-IV major depression disorders (MDD) in outpatients who were scheduled for routine office visits with physicians specializing in internal medicine, the BDI-PC was administered to 60 male and 60 female outpatients. The internal consistency of the BDI-PC was high (alpha 0.85), and the Mood Module from the Primary Care Evaluation of Mental Disorders was used to diagnose MDD. The BDI-PC scores were not significantly correlated with sex, age, ethnicity, or total number of medical diagnoses. A BDI-PC cutoff score of 4 and above yielded 98% maximum clinical efficiency with 97% (95% CI 82%–99%) sensitivity and 99% (95% CI 94%–99%) specificity rates, respectively, for identifying patients with and without MDD. The BDI-PC is discussed as an effective case-finding instrument for screening primary care patients for MDD.
Article
Fibromyalgia syndrome (FMS) is a chronic disorder that is characterized by widespread pain with localized tenderness. We aimed to investigate whether thermal therapy combining sauna therapy and underwater exercise improved pain, symptoms, and quality of life (QOL) in FMS patients. Forty-four female FMS patients who fulfilled the American College of Rheumatology (ACR) criteria received 12-week thermal therapy program comprising sauna therapy once daily for 3 days/week and underwater exercise once daily for 2 days/week. Pain, symptoms, and QOL were assessed using a pain visual analog scale (VAS), a fibromyalgia impact questionnaire (FIQ), and a short form 36-item questionnaire (SF-36), respectively. All of the patients reported significant reductions in pain and symptoms of 31-77% after the 12-week thermal therapy program, which remained relatively stable (28-68%) during the 6-month follow-up period (that is, the thermal therapy program improved both the short-term and the long-term VAS and FIQ scores). Improvements were also observed in the SF-36 score. Thermal therapy combining sauna therapy and underwater exercise improved the QOL as well as the pain and symptoms of FMS patients.
Article
Fibromyalgia syndrome (FMS) is a chronic syndrome characterized by widespread pain with tenderness in specific areas. We examined the applicability of Waon therapy (soothing warmth therapy) as a new method of pain treatment in patients with FMS. Thirteen female FMS patients (mean age, 45.2+/-15.5 years old; range, 25-75) who fulfilled the criteria of the American College of Rheumatology participated in this study. Patients received Waon therapy once per day for 2 or 5 days/week. The patients were placed in the supine or sitting position in a far infrared-ray dry sauna maintained at an even temperature of 60 degrees C for 15 minutes, and then transferred to a room maintained at 26-27 degrees C where they were covered with a blanket from the neck down to keep them warm for 30 minutes. Reductions in subjective pain and symptoms were determined using the pain visual analog scale (VAS) and fibromyalgia impact questionnaire (FIQ). All patients experienced a significant reduction in pain by about half after the first session of Waon therapy (11-70%), and the effect of Waon therapy became stable (20-78%) after 10 treatments. Pain VAS and FIQ symptom scores were significantly (p<0.01) decreased after Waon therapy and remained low throughout the observation period. Waon therapy is effective for the treatment of fibromyalgia syndrome.