Treating Chronic Tension-type Headache Not Responding to Amitriptyline Hydrochloride With Paroxetine Hydrochloride: A Pilot Evaluation

Authors

  • Kenneth A. Holroyd PhD,

    1. From the Department of Psychology (Drs. Holroyd and Labus) and the College of Osteopathic Medicine (Dr. Cordingley), Ohio University, Athens; Headache Treatment and Research (Drs. Holroyd and O'Donnell) and Ortho Neuro Inc. (Dr. O'Donnell), Westerville, Ohio; and the Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles (Dr. Labus).
    Search for more papers by this author
  • Jennifer S. Labus PhD,

    1. From the Department of Psychology (Drs. Holroyd and Labus) and the College of Osteopathic Medicine (Dr. Cordingley), Ohio University, Athens; Headache Treatment and Research (Drs. Holroyd and O'Donnell) and Ortho Neuro Inc. (Dr. O'Donnell), Westerville, Ohio; and the Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles (Dr. Labus).
    Search for more papers by this author
  • Francis J. O'Donnell DO,

    1. From the Department of Psychology (Drs. Holroyd and Labus) and the College of Osteopathic Medicine (Dr. Cordingley), Ohio University, Athens; Headache Treatment and Research (Drs. Holroyd and O'Donnell) and Ortho Neuro Inc. (Dr. O'Donnell), Westerville, Ohio; and the Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles (Dr. Labus).
    Search for more papers by this author
  • Gary E. Cordingley MD, PhD

    1. From the Department of Psychology (Drs. Holroyd and Labus) and the College of Osteopathic Medicine (Dr. Cordingley), Ohio University, Athens; Headache Treatment and Research (Drs. Holroyd and O'Donnell) and Ortho Neuro Inc. (Dr. O'Donnell), Westerville, Ohio; and the Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles (Dr. Labus).
    Search for more papers by this author

Address all correspondence to Dr. Kenneth A. Holroyd, 225 Porter Hall, Athens, OH 45701.

Abstract

Context.—In some individuals, chronic tension-type headache fails to respond to tricyclic antidepressant medications that often serve as first-line therapy.

Objective.—To evaluate the clinical efficacy of paroxetine hydrochloride for chronic tension-type headache not responding to amitriptyline hydrochloride.

Design and Setting.—Open-label trial of paroxetine conducted at 2 outpatient sites in Ohio.

Participants and Intervention.—Thirty-one adults (mean age, 37 years; 20 women) with chronic tension-type headache (mean, 25 headache days per month) who had failed to respond (less than 30% improvement) to treatment with either amitriptyline (n = 13) or matched placebo (n = 18). All participants were treated with paroxetine (up to 40 mg per day) in a 9-month protocol.

Outcome Measures.—Monthly headache index calculated as the mean of pain ratings (0 to 10 scale) recorded by participants in a diary 4 times per day, number of days per month with at least moderate pain (pain rating of 5 or greater), and analgesic medication use.

Results.—In patients who had not responded to amitriptyline, paroxetine failed to reduce chronic tension-type headaches or analgesic medication use. In patients who had not responded to placebo, paroxetine produced modest reductions in chronic tension-type headaches and analgesic use.

Conclusions.—We found no evidence that chronic tension-type headaches that failed to respond to tricyclic antidepressant therapy with amitriptyline improved when subsequently treated with paroxetine. More support was found for the efficacy of paroxetine in patients with chronic tension-type headaches who had failed to respond to placebo.

Ancillary