Efficacy and Tolerability of Amitriptylinoxide in the Treatment of Chronic Tension-Type Headache: A Multi-Centre Controlled Study

Abstract

Amitriptyline is the medication of first choice in the treatment of chronic tension-type headache. In 197 patients with chronic tension-type headache (87M and 110F with a mean age of 38 +/- 13 (18-68)) efficacy and tolerability of 60-90 mg amitriptylinoxide (AO) were compared with 50-75 mg amitriptyline (AM) and placebo (PL) in a double-blind, parallel-group trial consisting of a four weeks' baseline phase and 12 weeks of treatment. The primary study endpoint was a reduction of at least 50% of the product of headache duration and frequency and a reduction of at least 50% in headache intensity. Statistics used were Fisher's exact test and analysis of variance. No significant difference emerged between AO, AM and PL with respect to the primary study endpoint. Treatment response occurred in 30.3% of the AO, 22.4% of the AM and 21.9% of the PL group. A reduction in headache duration and frequency of at least 50% was found in 39.4% on AO, in 25.4% on AM and in 26.6% on PL (PAO-PL = .1384, PAM-PL = 1.000, PAO-AM = .0973). A reduction in headache intensity of at least 50% was found in 31.8% on AO, in 26.9% on AM and in 26.6% on PL (PAO-PL = .5657, PAM-PL = 1.000, PAO-AM = .5715). Trend analysis with respect to a significant reduction of headache intensity (p < 0.05) and the product of headache duration and frequency revealed a superior effect of AO.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychiatric comorbidity of chronic daily headache: Impact, treatment, outcome, and future studies

“…The mode of action may be related to the down-regulation of 5-hydroxytryptamine (5-HT) brainstem autoreceptors, which results from blockage of 5-HT reuptake [38] and is not related to their antidepressive actions [41]. Moreover, the comorbid depression symptoms before treatment did not influence analgesic effects of amitriptyline [34,39]. Bussone et al [40] and Saper et al [41] reported that fluoxetine also was effective in treating CDH and its comorbid depression.…”

Management of Chronic Tension-Type Headache With Tricyclic Antidepressant Medication, Stress Management Therapy, and Their Combination

“…1,2,8,9 Tricyclic antidepressants are the primary drug therapy for chronic tensiontype headache, with amitriptyline hydrochloride the first-line treatment. 2,[9][10][11][12] However, recent trials have reported little (Յ30%) or no improvement in chronic tension-type headaches [13][14][15] with amitriptyline. Additional information is therefore needed to confirm the benefits of this widely used medication for chronic tension-type headache.…”

Current and potential future drug therapies for tension-type headache

“…[40] demonstrated that 75 mg of amitriptyline administered daily significantly reduced headache duration compared with placebo in the last week of a 6-week study. A large multicenter, parallel group trial by Pfaffenrath et al [41] reported no difference between 50 to 75 mg of amitriptyline administered daily, 60 to 90 mg of amitriptylioxide administered daily, and placebo in all of the recorded endpoints of the study. Amitriptyline has marked side effects, but there was no difference in side-effect report between the amitriptyline and placebo groups.…”