Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache.
BACKGROUND
The tricyclic antidepressant amitriptyline is the only drug with prophylactic efficacy for chronic tension-type headache. However, amitriptyline is only moderately effective, with headache reduction of approximately 30%, and treatment is often hampered by side effects. Mirtazapine is a relatively new so-called noradrenergic and specific serotonergic antidepressant, which is more specific and therefore generally better tolerated.


OBJECTIVE
To evaluate the efficacy of mirtazapine.


METHODS
Twenty-four nondepressed patients with chronic tension-type headache were included in a randomized, double-blind, placebo-controlled, crossover trial. All patients had tried numerous other treatments. Mirtazapine 15 to 30 mg/day or placebo was each given for 8 weeks separated by a 2-week wash-out period.


RESULTS
Twenty-two patients completed the study. The primary efficacy variable, area-under-the-headache curve (AUC; duration x intensity), was lower during treatment with mirtazapine (843) than during treatment with placebo (1,275) (p = 0.01). Mirtazapine also reduced the secondary efficacy variables headache frequency (p = 0.005), headache duration (p = 0.03), and headache intensity (p = 0.03) and was well tolerated.


CONCLUSIONS
Mirtazapine reduced AUC by 34% more than placebo in difficult-to-treat patients. This finding is clinically relevant and may stimulate the development of prophylactic treatments with increased efficacy and fewer side effects for tension-type headache and other types of chronic pain.
Bendtsen
Lars
L
Danish Headache Center, University of Copenhagen, and Department of Neurology, Glostrup University Hospital, Copenhagen, Denmark. bendtsen@dadlnet.dk
Jensen
Rigmor
R
D058669:Adrenergic alpha-2 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D019540:Area Under Curve; D002908:Chronic Disease; D018592:Cross-Over Studies; D004244:Dizziness / Q000139:chemically induced; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D008875:Middle Aged; D000078785:Mirtazapine; D018377:Neurotransmitter Agents / Q000378:metabolism; D010147:Pain Measurement; D017661:Receptors, Presynaptic / Q000037:antagonists & inhibitors; D018781:Tension-Type Headache / Q000188:drug therapy*; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects
D058669:Adrenergic alpha-2 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists; D018377:Neurotransmitter Agents; D017661:Receptors, Presynaptic; D008803:Mianserin; D000078785:Mirtazapine