Anti-depressant medication and stress management therapy each reduce the frequency and intensity of tension-type headaches. A combination of the two may offer the greatest relief, according to a study appearing in the May 2 issue of the Journal of the American Medical Association.
Tension-type headaches are the kind of migraine. To chronic sufferers (frequent pain for more than six months) tension-type headaches can be disabling and cause the overuse of pain medicines. About 3 percent of women and 1.5 percent of men in the general population experience chronic tension-type headaches in a given year.
Anti-depressants are the primary drug therapy for chronic headaches. Behavioral therapies such as relaxation and stress management, though less studied, are also used to manage the associated pain. Recent research, however, has cast doubt on the effectiveness of both these treatments.
In a new study, Kenneth A. Holroyd, PhD of Ohio University and colleagues set out to determine the combined and separate effects of anti-depressant medication (AM) and stress management therapy (SMT) on headaches. The medications used were one of two possible tricycline-type anti-depressants, amitriptyline hydrochloride or nortriptyline.
From 1995 to 1998, 203 volunteers were recruited to the study. All participants, between 18 and 65 years old, had been diagnosed with chronic tension-type headaches. For one month these patients kept a diary listing headache intensity and pain medications taken. Headache intensities were ranked 4 times per day on a 0-10 scale.
Once baselines were established, the subjects were randomly divided into 4 groups. Fifty-three patients were assigned to get AM, which consisted of either amitriptyline hcl (up to 100mg per day) or nortriptyline (up to 75 mg per day). Another group of 48 patients received inactive placebo pills. Forty-nine subjects received SMT, which consisted of relaxation and cognitive coping exercises, and the placebo pills. The remaining 53 patients received both SMT and AM. Subjects continued to keep a their daily diaries for an eight month treatment phase along with periodic clinical visits.
The researchers compared the intensity and frequency of headaches and the number of times patients took pain medications among the 4 treatment groups.
By the end of the 8 month evaluation period, all three active treatments, but not the placebo, yielded similar improvements in reducing headache intensity and frequency and pain medication use. These improvements were more rapid in the AM and combined therapy groups than the SMT group.
A greater proportion of subjects in the AM plus SMT group (64 percent) showed clinically significant (greater than 50 percent) reductions in migraine scores compared with the AM only group (38 percent) and SMT only group (35 percent).
Eighty percent of the subjects who took AM reported adverse side effects, compared to 30 percent who took the placebo pills. The only side effects reported by more than 10 percent of either treatment group were dry mouth and drowsiness.