Treatment of Tension-type Headache in Chronic Tension-type Headache (≥15 Headache Days per Month)
This protocol addresses tension-type headache in the specific population of chronic tension-type headache — defined as headache occurring on 15 or more days per month on average for more than 3 months — where prophylactic pharmacotherapy is indicated.
Clinical Scenario
Headache occurring on 15 or more days per month on average for more than 3 months (180 or more days per year), fulfilling diagnostic criteria for chronic tension-type headache. Prophylactic pharmacotherapy should be considered in this patient group.
Treatment Approach
The pharmacotherapy approach for chronic tension-type headache in this setting involves specific agents from the antidepressant class — including tricyclic and tetracyclic compounds — which have demonstrated efficacy over placebo.
Agent selection, sequencing, and the complete regimen are available in the full protocol.
References
DOI: 10.1111/j.1468-1331.2010.03070.x
- Headache occurring on ‡15 days per month on average for >3 months (‡180 days per year) and fulfilling criteria B–D.
- Prophylactic pharmacotherapy should be considered in patients with chronic TTH, and it can be considered in patients with very frequent episodic TTH.
- The tricyclic antidepressant clomipramine 75–150 mg daily and the tetracyclic antidepressants maprotiline 75 mg daily and mianserin 30–60 mg daily have been reported more effective than placebo.
- Mirtazapine or venlafaxine are probably effective, whilst the older tricyclic and tetracyclic antidepressants, clomipramine, maprotiline and mianserin, may be effective.
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