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Drugs and Stress Management Together Best Manage Chronic Tension Headache: Clinical Trial Proves Benefit of Combined Therapies

For release: Tuesday, May 1, 2001

Stress management techniques such as relaxation and biofeedback can help treat chronic tension headaches, especially in combination with medicine, according to research funded by the National Institute of Neurological Disorders and Stroke (NINDS). Results of the first placebo-controlled trial comparing medicines alone vs. medicine plus stress management appear in the May 2, 2001, issue of the Journal of the American Medical Association. 1

Tension-type headaches affect some 2-3 percent of the nation's population on a chronic basis, with twice as many women affected as men. Most people use over-the-counter analgesics to treat their headaches but overuse can make the headache worse and unresponsive to treatment. Stress management therapy for headache is a cognitive behavioral approach that teaches people to recognize and manage early headache signs, cope with pain and address stress-generating issues, and possibly prevent headache.

Kenneth Holroyd, Ph.D., of Ohio University in Athens, and colleagues enrolled 203 adults (with a mean of 26 chronic tension headaches a month) in an 8-month trial to study the effectiveness of behavioral and pharmacological therapies for chronic tension headache. Patients were randomly assigned to one of four treatments: tricyclic antidepressant medication (the primary drug therapy for chronic tension-type headaches), placebo, stress management therapy plus placebo, and stress management therapy plus antidepressant medication. Patients recorded headache activity and the use of analgesic and study medications in a daily diary, as well as measures of disability caused by headaches.

According to Dr. Holroyd and his colleagues, three of the four treatments—tricyclic drugs alone, tricyclics plus stress management, and stress management plus placebo— reduced chronic tension-type headache activity, analgesic use, and headache related disability. Combined drug and behavioral therapy produced a clinically significant reduction (≥ 50%) in the Headache Index (a measure of overall headache activity) for more patients than did either therapy alone. Patients who took placebos throughout the trial did not report any reduction in headache activity.

The study provides the first evidence that chronic tension-type headaches respond to brief behavioral therapy to the same degree as antidepressant medication alone. However, behavioral techniques may need to be repeated for several months before they have an impact on daily headaches.

John R. Marler, M.D., Associate Director for Clinical Trials at the NINDS, said "This study establishes the effectiveness of tricyclic medication for chronic tension headache and provides new information about the benefits of the combined medication and behavioral treatment. These findings suggest new avenues of research in the prevention and treatment of other types of headache."

Tension headache is caused by prolonged tightening of muscles in the head and neck. This most common form of headache is classified two ways: episodic, with fewer than 15 attacks per month typically triggered by some form of environmental or internal stress, and chronic, occurring on 15 or more days a month, with varied pain throughout the day. Symptoms include a dull ache on both sides of the head, tightness or sensations of pressure around the scalp or neck, and depression. Many sufferers also find it difficult to sleep.

The NINDS, a part of the National Institutes of Health, is the nation's leading supporter of research on the brain and nervous system. The NINDS is now celebrating its 50th anniversary.

1 Holroyd, Kenneth A.; O'Donnell, Francis J.; Stensland, Michael; Lipchik, Gay L.; Cordingley, Gary E.; Carlson, Bruce W. "Management of Chronic Tension-Type Headache With Tricyclic Antidepressant Medication, Stress Management Therapy, and Their Combination." Journal of the American Medical Association, May 2, 2001, Vol. 285, No. 17, 2208-2215.

Reporters: for more information, contact Paul Girolami or Margo Warren at (301) 496-5751.


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Last Modified September 23, 2015