Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: Dr Holroyd and colleagues1 found that tricyclic antidepressants (TCAs) and
stress management therapy (SMT) had similar modest effects in treating chronic
tension headaches (CTHs). However, their study may have limited validity.
In treating a cohort of patients with chronic tension-type headache with antidepressant
medications, it is important to ensure that comorbid depression is not present.
The authors state that comorbid psychiatric problems are common in patients
with CTH. Since the exclusion criteria did not include evaluation for depressive
symptoms (other than suicide risk), it is not clear if the beneficial effects
of amytriptyline (up to 100 mg) or nortryptiline (up to 75 mg) were due to
specific antiheadache effects or to their antidepressant actions.
Rifkin W, Ward L. Antidepressant Medication for Chronic Tension Headache. JAMA. 2001;286(16):1969-1970. doi:10.1001/jama.286.16.1969