ReviewTreatment of chronic headache with antidepressants: a meta-analysis1☆,
Section snippets
Material and methods
We searched MEDLINE (1966–December 1998), PsycLIT (1974–December 1998), and EMBASE (1974–December 1998) using the following text and key words (all languages, limited to “human”): antidepressive agents, serotonin uptake inhibitors, monoamine oxidase inhibitors, tricyclic, amoxapine, clomipramine, trimipramine, desipramine, doxepin, imipramine, maprotiline, amitriptyline, nortriptyline, protriptyline, trazodone, nefazodone, fluoxetine, fluvoxamine, paroxetine, sertraline, femoxetine,
Study characteristics
The literature search identified 41 randomized, placebo-controlled trials of antidepressant use in headache. Data from three of these studies could not be pooled because the articles did not report sample size or variance, which are necessary for combining data 15, 16, 17, 18. The remaining 38 studies (Table 1; references 6, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55) had moderate quality
Discussion
Meta-analysis of the 38 published randomized controlled trials suggests that antidepressants are effective in reducing chronic headache pain. Patients receiving antidepressants were twice as likely to improve, with about 3 patients needing treatment to improve 1 patient’s symptoms. Patients had a mean reduction in headache burden of nearly 1 SD unit and a reduced analgesic consumption of 0.7 SD units. A difference of 0.8 SD units is commonly considered to be a large treatment effect (58).
Acknowledgements
The authors wish to acknowledge the assistance of Robert Mohrman in the systematic search of the literature.
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Supported by a grant from the MacArthur Foundation Initiative on Depression in Primary Care (PGO).
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Disclaimer: The views in this article reflect those of the authors and are not intended to represent in any way those of the U.S. Army or the Department of Defense.