AMITRIPTYLINE IS EFFECTIVE IN CHRONIC BUT NOT IN EPISODIC TENSION-TYPE HEADACHE - PATHOGENETIC IMPLICATIONS

The tricyclic antidepressant, amitriptyline, is an effective drug for the treatment of chronic tension-type headache and for other chronic p ain syndromes, but it is also effective in the prophylaxis of an episo dic type of headache such as migraine. However, its efficacy in episod ic tension-type headache has not yet been clarified. We compared the e fficacy of amitriptytine (25 mg/day) in 82 nondepressed patients with either chronic or episodic tension-type headache in an open-label stud y. Amitriptyline significantly reduced (P<0.05) frequency end duration of headache as well as analgesic consumption in chronic, but not in e pisodic, tension-type headache. Further placebo-controlled trials, pos sibly with higher . doses of amitriptyline, might confirm a the differ ent pattern of response to amitriptyline can be explained in terms of different involvement of central nociception and of peripheral myofasc ial factors in the chronic and in the episodic forms of tension-type h eadache.