Clinical question
How effective are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for preventing episodic and chronic tension-type headaches in adults?
Bottom line
Over two months of treatment, SSRIs or venlafaxine were no more effective than placebo or amitriptyline in reducing headache frequency in patients with chronic tension-type headache. SSRIs seemed to be less effective than tricyclic antidepressants (TCAs) in terms of intake of analgesic medications. TCAs were associated with more adverse events; however, this did not cause a greater number of withdrawals.
Caveat
These results were based on poor quality, small, short-term trials (no more than four months). There were no studies comparing SSRIs or SNRIs with other treatments, such as botulinum toxin, or non-drug therapies (e.g. psycho-behavioural treatments, manual therapy, acupuncture).
Context
Tension-type headache is very common, and has high social and economic relevance. As serotonin and other neurotransmitters may have a role in pain mechanisms, SSRIs and SNRIs have been evaluated for the prevention of tension-type headache.
Cochrane Systematic Review
Banzi R et al. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults. Cochrane Reviews, 2015, Issue 5. Art. No.: CD011681.DOI: 10.1002/14651858. CD011681. This review contains 8 studies involving 412 participants.
Cochrane Systematic Reviews for primary care practitioners
Developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health and New Zealand Doctor. PEARLS are meant for educational use and not to guide clinical care. New Zealanders can access the Cochrane Library free via www.cochrane.org.nz
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