480 SSRIs and SNRIs ineffective for preventing tension-type headaches

August 20, 2016

written by Brian R McAvoy.

Clinical Question
How effective are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for preventing episodic and chronic tension-type headaches in adults?

Bottom Line
Over two months of treatment, SSRIs or venlafaxine were no more effective than placebo or amitriptyline in reducing headache frequency in patients with chronic tension-type headache. SSRIs seemed to be less effective than tricyclic antidepressants (TCAs) in terms of intake of analgesic medications. TCAs were associated with more adverse events; however, this did not cause a greater number of withdrawals.


These results were based on poor quality, small, short-term trials (no more than four months). There were no studies comparing SSRIs or SNRIs with other treatments, such as botulinum toxin, or non-drug therapies (e.g. psycho-behavioural treatments, manual therapy, acupuncture).


Tension-type headache is very common, and has high social and economic relevance. As serotonin and other neurotransmitters may have a role in pain mechanisms, SSRIs and SNRIs have been evaluated for the prevention of tension-type headache.

Cochrane Systematic Review

Banzi R et al. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults. Cochrane Reviews, 2015, Issue 5. Art. No.: CD011681.DOI: 10.1002/14651858. CD011681. This review contains 8 studies involving 412 participants.

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