The Use of Antidepressants for Headache Prophylaxis

Smitherman, Todd A.; Walters, A. Brooke; Maizels, Morris; Penzien, Donald

doi:10.1111/j.1755-5949.2010.00170.x

Cited by 51 publications

(33 citation statements)

References 54 publications

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“…Beyond symptom overlap, individuals with migraine and TTH endorse similar attack triggers [23,33,36,57], have elevated rates of psychiatric comorbidities [8,19,37,47], and respond well to EMG biofeedback and other behavioral interventions [17,18,35,39,42]. Merging lines of evidence also suggest indirectly that migraine and TTH may share pathophysiological underpinnings, as evidenced by the prevalence of central sensitization in chronic forms of migraine and TTH [11], efficacy of amitriptyline as a preventive treatment for both conditions [7,18,49,51], and the finding that sumatriptan is most effective for migraine when neck pain (a common feature of TTH) is present [21]. …”

Section: Introductionmentioning

confidence: 99%

Are migraine and tension-type headache diagnostic types or points on a severity continuum? An exploration of the latent taxometric structure of headache

Turner

Smitherman

Black

et al. 2015

Pain

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The objective of this study was to assess whether migraine and tension-type headache (TTH) are best viewed as discrete entities or points on a severity continuum using taxometric analysis. Historically, classification systems have conceptualized the primary headache disorders of migraine and TTH as fundamentally different disorders that are differentiated by their characteristic symptom profiles and, as such, imply differing pathophysiologies and required treatments. Despite this categorical nosology, findings continue to emerge suggesting that migraine and TTH instead reflect dimensions of severity within the same headache construct. However, few studies have assessed this issue using taxometric statistical analyses or investigated how this taxonomic structure varies as a function of age and headache frequency. We conducted a latent-mode factor analysis of headache symptomatology obtained from 3449 individuals with headache from 2 previous, large-scale cross-sectional studies of primary headache sufferers (Martin et al., 2005, and Smitherman and Kolivas, 2013). Stratified taxometric analyses suggest that the validity of a categorical vs dimensional classification varies as a function of sample characteristics. Specifically, graphical results revealed that high headache frequency (≥ 15 d/mo) and younger age (≤ 24 years old) were associated with unimodal distributions suggestive of a dimensional construct of primary headache, whereas lower headache frequency and older age were associated with bimodal distributions characteristic of discrete diagnostic entities. Conceptualizing primary headache as a severity continuum was supported for young adults and those with frequent headaches. The distinctions of a categorical classification system were supported for adults (> 24 years old) and those with infrequent headache.

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Section: Introductionmentioning

confidence: 99%

Are migraine and tension-type headache diagnostic types or points on a severity continuum? An exploration of the latent taxometric structure of headache

Turner

Smitherman

Black

et al. 2015

Pain

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“…We believe that a pharmacological treatment tailored on each patient should be always taken into account in these cases. Considering their efficacy in several headache forms [4,5] antidepressants may be the first choice.…”

Section: Discussionmentioning

confidence: 99%

Persistent orthostatic headache without intracranial hypotension: which treatment?

Curone¹,

Cecchini²,

Chiapparini³

et al. 2015

Neurol Sci

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Orthostatic headache can be the leading symptom of intracranial hypotension, however, not all orthostatic headaches are due to cerebrospinal fluid leaks and these forms can be a clinical problem, especially for treatment. Aim of this study was to review patients with persistent orthostatic headache in whom a detailed head and spinal MRI follow-up did not reveal any sign of intracranial hypotension and to evaluate which treatment can be considered the first choice. Patients admitted to our headache center for evaluation of persistent orthostatic headache and followed after first admission with clinical and neuroradiological controls were systematically reviewed. 11 patients (7 M, 4 F) followed in a period lasted from 10 months up to 2 years were studied. Six patients (54, 5 %) reported a MRI performed previously elsewhere with a suspect diagnosis of intracranial hypotension which was not confirmed at MRI at our hospital such as during the radiological follow-up. Three patients (27.2 %) had developed orthostatic headache short after a neck or head trauma with no evidence of neuroradiological pathological signs and two patients (18 %) had a previous history of psychiatric disorder. We administrated antidepressants in five patients, atypical neuroleptic in three patients, association of antidepressant and antipsychotic in one patient and muscle relaxants in two cases. All patients showed a certain improvement of headache in the weeks after introduction of the pharmacological treatment; six (54, 5 %) had pain relief during the follow-up and five (45, 5 %) were pain free at the last clinical control. We found out that patients with the best outcome were the ones treated with antidepressants. Persistent orthostatic headache without any neuroradiological sign of intracranial hypotension is a challenging problem for clinicians. Although the International Classification of Headache Disorders (ICHD-3 beta version) criteria suggests the possibility of epidural blood patch in orthostatic headache without causes, we believe that a pharmacological treatment tailored on each patient should be always considered and antidepressants can be the first choice.

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“…The SSRIs, while agents of choice for PTSD, are not effective for migraine prophylaxis [79,80], and the anticonvulsants currently used for CDH do not have consistent empirical support as primary agents for treating PTSD. The dosage of amitriptyline required to treat PTSD typically exceeds the required dosage for reducing headache, and adverse events often prompt discontinuation at these higher doses.…”

Section: Pharmacologic Treatment and Botulinum Toxinmentioning

confidence: 98%

Treatment of PTSD and Chronic Daily Headache

Smitherman

Black

Davis

2014

Curr Treat Options Neurol

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Posttraumatic stress disorder (PTSD) is often comorbid with chronic migraine (CM) and chronic tension-type headache (CTTH). Trauma-focused cognitive behavioral psychotherapies, selective serotonin reuptake inhibitors (SSRIs), and venlafaxine have demonstrated efficacy in the treatment of PTSD. Amitriptyline, topiramate, sodium valproate, and botulinum toxin A are efficacious for treatment of chronic daily headache (CDH). Treatment studies on individuals with CDH and comorbid PTSD, however, are limited. As such, multiple therapeutic agents or modes of interventions typically are necessary, such that comprehensive treatment simultaneously utilizes approaches with established efficacy for each individual condition.

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The Use of Antidepressants for Headache Prophylaxis

Cited by 51 publications

References 54 publications

Are migraine and tension-type headache diagnostic types or points on a severity continuum? An exploration of the latent taxometric structure of headache

Are migraine and tension-type headache diagnostic types or points on a severity continuum? An exploration of the latent taxometric structure of headache

Persistent orthostatic headache without intracranial hypotension: which treatment?

Treatment of PTSD and Chronic Daily Headache

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