Prophylactic medications ineffective in chronic tension-type headache

January 01, 0001

Prophylactic medications ineffective in chronic tension-type headache

Tension-type headache (TTH) is a common problem seen in family medicine, and for some patients can be a chronic issue. These Dutch researchers performed a systematic review and meta-analysis to assess the efficacy and side effects of prophylactic drugs for chronic TTH in adults. They selected randomized trials that reported the effects of prophylactic medicaitons in TTH using pain measurements (intensity, frequency, duration, improvement or index) as outcome measure. Two authors independently assessed the risk of bias in the studies and extracted data from the original reports.

The authors foundreport: "We included 44 trials (3399 patients), of which 15 (34.1%) were considered to be of low risk of bias. Main types of medications studied were antidepressants, muscle relaxants, benzodiazepines and vasodilator agents. Overall, antidepressants were no more effective than placebo, and there were no significant differences between different types of antidepressants. There was conflicting evidence about the effectiveness of benzodiazepines and vasodilator agents compared with placebo. Furthermore, there was limited evidence that propranolol had negative effects on depression in TTH patients, when compared with placebo or biofeedback. There was no evidence concerning the effectiveness of muscle relaxants alone or 5-HT receptor agonist compared with placebo."

The authors concluded: "Overall, antidepressants were no more effective on headache intensity or frequency and analgesic use than placebo. Propranolol seemed to have negative effects on depression in TTH patients when compared with placebo or biofeedback. No evidence was found for the use of muscle relaxants alone or 5-HT receptor agonist."

This meta-analysis finds no consistent evidence for a benefit of prophylactic medications in treating chronic tension-type headache.

For the full abstract, click here.

Family Practice 27(2):151-165, April 2010 © The Author 2009
Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review. Arianne P Verhagena, Léonie Damena, Marjolein Y Bergera, Jan Passchierb and Bart W Koesa. Correspondence to Arianne P Verhagena: [email protected]

Category: N. Neurological. Keywords: tension-type headache, tension headache, prophylaxis, anti- depressants, propranolol, systematic review with meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 11 May 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.