Alexander W. Chessman, MD
Are prophylactic drugs effective for tension-type headache (TTH) in adults?
Included studies compared oral prophylactic drugs (antidepressants, muscle relaxants, benzodiazepines, vasodilator agents, and antipsychotics) with placebo, other drugs, or nonpharmacologic treatments for TTH in adults (≥ 18 y) and reported ≥ 1 of the following outcome measures: headache, analgesic use, depression, or adverse events.
MEDLINE, EMBASE/Excerpta Medica, and CINAHL (all to Aug 2009); Cochrane Controlled Trials Register and Cochrane Library (issue 2, 2009); and reference lists were searched for randomized controlled trials (RCTs). 44 RCTs (n = 3399, age range 18 to 87 years, 46% to 100% women where reported) were included. Trials were assessed for study quality based on the Delphi list, with the addition of an item for withdrawal/dropout rate unlikely to cause bias. Mean quality score was 4.2; 15 studies had low risk for bias (scores ≥ 6/10). Mean baseline period was 2.3 weeks, mean treatment period was 8.2 weeks, and mean follow-up period was 1.9 weeks.
Statistical heterogeneity precluded valid pooling of study results. Results for high-quality studies (scores ≥ 6/10) with adequate power are in the Table.
Prophylactic drugs (antidepressants, muscle relaxants, benzodiazepines, vasodilator agents, and antipsychotics) do not seem to be effective for tension-type headache in adults given the limited evidence.
Effectiveness of prophylactic drugs for tension-type headache in adults (high-quality studies with adequate power)*
*RCT = randomized controlled trial
Chessman AW. Review: Evidence for the effectiveness of prophylactic drugs for tension-type headache in adults is limited. Ann Intern Med. 2010;153:JC4–8. doi: 10.7326/0003-4819-153-8-201010190-02008
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Published: Ann Intern Med. 2010;153(8):JC4-8.
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