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October 24/31, 2001

Antidepressant Medication for Chronic Tension Headache

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(16):1969-1970. doi:10.1001/jama.286.16.1969

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.