Reasons are advanced for believing that migraine and tension-type headaches are a continuum and that whether migraine or tension-type headache develops at any particular time is dependent on the relative vascular nociceptive, myofascial nociceptive and supraspinal (emotional) inputs that converge on and are integrated by the subnucleus caudalis (medullary dorsal horn).
The prophylaxis of both these two types of headache involves reducing each of these various inputs and therefore a polytherapeutic approach is essential. The measures required include pharmacotherapy, psychotherapy and acupuncture.
The aetiology and treatment of primary myofascial trigger point cephalaigia is also discussed.
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