EFFECTIVENESS OF NON-PHARMACOLOGICAL METHODS IN CHRONIC TENSION-TYPE HEADACHE SYNDROME ACCOMPANIED BY DEPRESSION
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Abstract
The aim of this study was to evaluate the clinical effectiveness of various non-pharmacological therapeutic interventions in patients with chronic tension-type headache (TTH) accompanied by comorbid depression, and to explore their impact on pain intensity, psycho-emotional well-being, and overall quality of life. Chronic TTH is a prevalent primary headache disorder frequently associated with depressive symptoms, which exacerbate headache severity, impair daily functioning, and reduce psychosocial resilience. Pharmacological treatments, while effective, are often limited by adverse effects and the risk of medication-overuse headache, highlighting the importance of adjunctive or alternative non-pharmacological approaches.
This study investigated multiple therapeutic modalities, including transcranial magnetic stimulation (TMS), cognitive-behavioral therapy (CBT), acupuncture, electromyographic biofeedback, structured relaxation techniques, and targeted physical exercises. Each intervention was examined for its mechanism of action and clinical efficacy. TMS modulates cortical excitability and regulates trigeminovascular and somatosensory pathways, thereby reducing headache frequency and alleviating depressive symptoms. CBT and mindfulness-based approaches target maladaptive cognitive patterns and stress responses, improving coping strategies and psycho-emotional stability. Acupuncture and dry needling stimulate endogenous analgesic systems and modulate peripheral and central pain pathways. EMG-biofeedback facilitates voluntary control of muscle tension, particularly in cranio-cervical muscles implicated in TTH pathophysiology, while relaxation and coordinated physical exercises reduce sympathetic overactivity, improve musculoskeletal function, and enhance central pain modulation.
Conclusion: The results indicate that non-pharmacological interventions effectively reduce headache intensity and frequency, alleviate depressive symptoms, and enhance functional capacity and quality of life. Importantly, a comprehensive multimodal approach allows for reduced reliance on pharmacotherapy or even its temporary avoidance, while maintaining high therapeutic efficacy. These findings support the integration of non-pharmacological strategies as a core component of holistic management for chronic TTH with comorbid depression, offering a safe, evidence-based, and patient-centered alternative to conventional pharmacological therapy.
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