Treating chronic tension-type headache not responding to amitriptyline hydrochloride with paroxetine hydrochloride: a pilot evaluation.
BACKGROUND
In some individuals, chronic tension-type headache fails to respond to tricyclic antidepressant medications that often serve as first-line therapy.


OBJECTIVE
To evaluate the clinical efficacy of paroxetine hydrochloride for chronic tension-type headache not responding to amitriptyline hydrochloride.


METHODS
Open-label trial of paroxetine conducted at 2 outpatient sites in Ohio.


METHODS
Thirty-one adults (mean age, 37 years; 20 women) with chronic tension-type headache (mean, 25 headache days per month) who had failed to respond (less than 30% improvement) to treatment with either amitriptyline (n = 13) or matched placebo (n = 18). All participants were treated with paroxetine (up to 40 mg per day) in a 9-month protocol.


METHODS
Monthly headache index calculated as the mean of pain ratings (0 to 10 scale) recorded by participants in a diary 4 times per day, number of days per month with at least moderate pain (pain rating of 5 or greater), and analgesic medication use.


RESULTS
In patients who had not responded to amitriptyline, paroxetine failed to reduce chronic tension-type headaches or analgesic medication use. In patients who had not responded to placebo, paroxetine produced modest reductions in chronic tension-type headaches and analgesic use.


CONCLUSIONS
We found no evidence that chronic tension-type headaches that failed to respond to tricyclic antidepressant therapy with amitriptyline improved when subsequently treated with paroxetine. More support was found for the efficacy of paroxetine in patients with chronic tension-type headaches who had failed to respond to placebo.
D000328:Adult; D000639:Amitriptyline / Q000627:therapeutic use*; D000700:Analgesics / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D017374:Paroxetine / Q000627:therapeutic use*; D010865:Pilot Projects; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use*; D018781:Tension-Type Headache / Q000188:drug therapy*; D017211:Treatment Failure
D000700:Analgesics; D000929:Antidepressive Agents, Tricyclic; D017366:Serotonin Receptor Agonists; D000639:Amitriptyline; D017374:Paroxetine