Tricyclics may prevent tension-type headache and reduce analgesic use

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Tricyclics may prevent tension-type headache and reduce analgesic use

A systematic review of prophylactic treatment of tension-type headache found high quality evidence that tricyclic antidepressants (TCAs) reduced the headache frequency by 4.8 per month compared with placebo.1 They also reduced the doses of analgesic medication by 21 doses per month.

The range of doses ranged from 10 mg per day to 150 mg and in the placebo studies the doses ranged from 50 mg to 150 mg. The authors implied that 10 mg daily was too low but did not have the data to support that claim.  TCAs were more effective than SSRIs and buspirone.

Low quality studies found that TCAs were equivalent to behaviour therapy, spinal manipulation, intra-oral orthotics, and massage. The authors commented, “additional research is needed to strengthen the comparison of TCAs to alternative pharmacological and non-pharmacological treatments.”


  1. Tricyclic and Tetracyclic Antidepressants for the Prevention of Frequent Episodic or Chronic Tension-Type Headache in Adults: A Systematic Review and Meta-Analysis (2017)  Click here

    Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

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    As published in NZ Doctor 25/10/2017