In May 2001 The Journal of the American Medical Association (JAMA) included a report on a recent study to determine effective treatment of chronic tension headaches. The research team, led by Kenneth A. Holroyd, Ph.D. of Ohio University, wanted to learn whether treatment with anti-depressant medications and/or stress management therapy really worked. They signed on 203 participants, ruling out people who were pregnant or breastfeeding, or suffering also from migraine, a chronic pain condition such as arthritis, or a mental disorder. Of the people chosen, 63% said they had daily or almost daily headaches, and 79% said they had consulted their doctor about headaches, but 49% of that group had stopped going to the doctor for this issue. We can understand that - probably frustrated by lack of help or understanding, and the cost of drugs.
The first step was one I've advocated many times - keeping a headache diary. Each participant recorded headache activity 4 times a day, and rated the severity of pain. Then they began treatment. Some of them were given a placebo, and the results of the study may have been skewed somewhat by the fact that a considerable number of these patients stopped taking the placebo due to lack of results, and requested another treatment or just dropped out of the study.
However, the other participants showed improvement. In the anti-depressant-alone group, those who could tolerate it took amitriptyline hydrochloride. People who had an adverse reaction to this drug were switched to nortriptyline hydrochloride. Another group was given learning sessions in stress management skills - relaxation, coping, etc. The final group took the medication and also learned stress management techniques.
There was quicker response to the anti-depressant medication, but learning stress management takes time and effort. Eventually the group that had medication plus stress management had the best results. Almost 2/3 of that group reported significant improvement. The figures?
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