STUDY OBJECTIVE: Tension-type headache is the most common primary headache worldwide, significantly reducing individuals' quality of life. Although nonsteroidal anti-inflammatory drugs are commonly used for the pharmacologic treatment of tension-type headache, complementary and alternative treatment methods are gaining increasing importance. In this context, virtual reality technology stands out as a noninvasive option, particularly in pain management. This study investigates the analgesic effects and acute mood changes associated with virtual reality and classical music therapy in tension-type headache patients.
METHODS: This randomized controlled trial involved 140 patients diagnosed with tension-type headache, divided into 2 groups. The control group received intravenous 25-mg dexketoprofen trometamol, whereas the intervention group was provided with virtual reality goggles to listen to classical music in a simulated forest environment in addition to this treatment. Pain intensity was assessed using the visual analog scale (VAS), whereas mood changes were measured using a 5-choice ordinal rating scale.
RESULTS: The mean (SD) values for VAS-0, VAS-30, VAS-60, and VAS-120 in the control group were found to be 80.5 (11.2), 60.1 (17.0), 51.0 (18.0), and 45.9 (19.9), respectively, whereas the mean (SD) values for VAS-0, VAS-30, VAS-60, and VAS-120 in the intervention group were calculated as 79.8 (11.3), 40.35 (26.6), 21.9 (22.2), and 12.1 (15.7), respectively. Pain intensity was observed lower in the intervention group throughout the treatment than the control group. When ?VAS-30, ?VAS-60, and ?VAS-120 values were examined, the values in the control group were 20.3 (13.4), 29.4 (15.9), and 34.5 (17.9), respectively, whereas in the intervention group, these values were 39.5 (22.5), 57.9 (20.1), and 67.7 (15.5), respectively. Regarding the ?VAS%-30, ?VAS%-60, and ?VAS%-120 values, the control group had values of 25.5 (16.2), 36.8 (19.4), and 43.2 (21.9), respectively, whereas the intervention group had values of 50.9 (30.5), 73.6 (25.7), and 85.4 (18.4), respectively. At 120 minutes, the proportion of patients reporting a 5-choice ordinal rating scale score of 4 or 5 (indicating a positive mood) was significantly higher in the intervention group: 81.4% versus 31.4%, with a difference of 50% (95% confidence interval 35.8% to 64.2%).
CONCLUSION: The findings suggest that the combination of virtual reality and classical music effectively manages pain and improves mood in tension-type headache patients. This approach may reduce medication use and offers an innovative alternative for tension-type headache management, consistent with similar studies in the literature.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
Interesting RCT showing that music and virtual reality goggles set in a forest likely improves tension headache. Weaknesses include a strawman comparator - an NSAID, when there is plenty of evidence that other options are more effective for HA resolution - and the population being limited to those who met International Classification of HA Disorders Tension type HA to be included (most ED physicians classify HA as either "worrisome for serious pathology" or "not worrisome" rather than subtypes). Nonetheless, the intervention showed relatively impressive results, and is certainly something that could be recommended for patients at home.
Physician rater
This is a very interesting article for a promising therapeutic option.
Physician rater
For patients with acute tension-type headaches, incorporating a relaxing forest virtual reality (VR) environment accompanied by classical music with standard non-steroidal anti-inflammatory drug (NSAID) therapy appears to be an effective and safe method of significantly improving pain relief and mood compared with NSAIDs alone. This approach could reduce the need for additional medication and improve patient well-being during acute headache episodes. However, proper training of healthcare providers in using VR hardware and the cost of the devices should be considered.
Physician rater
I enjoyed reading this study and the results were predictable. The authors could have done better blinding in the control group by a VR without showing any environment. Also, the assessment of mood in tension-type headache might be further described and interpreted.
, McMaster University