Abstract
To assess the efficacy and tolerability of prophylactic drugs for chronic tension-type headache (TTH) in adults. We searched several databases from inception to August 2009. We selected randomized trials that reported the effects of prophylactic drugs in patients with TTH, with a pain measure (intensity, frequency, duration, improvement or index) as outcome measure. Two authors independently assessed risk of bias and extracted data from the original reports. A data synthesis was carried out according to the type of medication. We included 44 trials (3399 patients), of which 15 (34.1%) were considered to be of low risk of bias. Main types of medications studied were antidepressants, muscle relaxants, benzodiazepines and vasodilator agents. Overall, antidepressants were no more effective than placebo, and there were no significant differences between different types of antidepressants. There was conflicting evidence about the effectiveness of benzodiazepines and vasodilator agents compared with placebo. Furthermore, there was limited evidence that propranolol had negative effects on depression in TTH patients, when compared with placebo or biofeedback. There was no evidence concerning the effectiveness of muscle relaxants alone or 5-HT receptor agonist compared with placebo. Overall, antidepressants were no more effective on headache intensity or frequency and analgesic use than placebo. Propranolol seemed to have negative effects on depression in TTH patients when compared with placebo or biofeedback. No evidence was found for the use of muscle relaxants alone or 5-HT receptor agonist.
Highlights
Tension-type headache (TTH), known as tension headache or muscle contraction headache, is the most commonly experienced type of headache
Chronic TTH has been defined in the classification of the International Headache Society (IHS) as headache frequency of at least 15 days a month during at least 6 months
Search strategy Medline, Pubmed, Cinahl, Cochrane and Embase were searched from inception to August 2009 and the Cochrane Controlled Trials Register, Cochrane Library using the terms ‘tension-type headache’, ‘tension headache’, ‘stress headache’ or ‘muscle contraction headache’ together with the search strategy for identifying randomized controlled trials described by Robinson and Dickerson.[9]
Summary
Tension-type headache (TTH), known as tension headache or muscle contraction headache, is the most commonly experienced type of headache. Populationbased studies suggest 1-year prevalence rates of TTH of 35–40% in adults.[1,2] Chronic TTH has been defined in the classification of the International Headache Society (IHS) as headache frequency of at least 15 days a month during at least 6 months. The headache is usually pressing/tightening in quality, mild or moderate in severity, bilateral and does not worsen with routine physical activity.[3,4] In addition, no more than one additional clinical feature of migraine (nausea, photophobia or phonophobia) is permitted and no vomiting.[4]. TTH is common, the pathophysiology and likely mechanism remain unclear. The pathophysiology is considered to be multifactorial, involving factors from the central and peripheral nervous system as well as environmental factors.[5]
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