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To the Editor: Dr Holroyd and colleagues¹ found that tricyclic antidepressants (TCAs) and stress management therapy (SMT) had similar modest effects in treating chronic tension headaches (CTHs). However, their study may have limited validity. In treating a cohort of patients with chronic tension-type headache with antidepressant medications, it is important to ensure that comorbid depression is not present. The authors state that comorbid psychiatric problems are common in patients with CTH. Since the exclusion criteria did not include evaluation for depressive symptoms (other than suicide risk), it is not clear if the beneficial effects of amytriptyline (up to 100 mg) or nortryptiline (up to 75 mg) were due to specific antiheadache effects or to their antidepressant actions.

Furthermore, as SMT was not compared to placebo therapy (ie, nontherapeutic clinical contact), all that can reliably be concluded is that SMT was better than placebo medication. It is unclear if this was . . . [Full Text of this Article]

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RELATED ARTICLE

Management of Chronic Tension-Type Headache With Tricyclic Antidepressant Medication, Stress Management Therapy, and Their Combination: A Randomized Controlled Trial
Kenneth A. Holroyd, Francis J. O'Donnell, Michael Stensland, Gay L. Lipchik, Gary E. Cordingley, and Bruce W. Carlson
JAMA. 2001;285(17):2208-2215.
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