[Treatment of chronic tension type headache with mirtazapine and amitriptyline]

The mechanisms at play in the production of tension type headaches (TTH) are partially unknown. Some of the aspects that have been discussed in connection with this issue include genetic, vascular and biochemical factors and even a predisposition of certain personalities to suffer from this kind of pain. Yet, the relation between neurotransmitters like noradrenalin (NAd) and serotonin (5 HT) and chronic TTH (CTTH) seems to be quite clear and hence the use of antidepressants that act on these substances in the pharmacological treatment of CTTH. In this study, the qualitative and quantitative efficiency of amitriptyline is compared with that of mirtazapine (two antidepressants that act on NAd and 5 HT) in the prophylaxis of CTTH.

A sample of 60 patients with CTTH criteria was divided into two groups, and subjects were administered one of the drugs at 50% random for six months. Group I was administered 25 mg of amitriptyline and group II received 30 mg of mirtazapine, both given in a single night time oral dose. Later, the two groups were compared before and after treatment, taking into account the following aspects: objective and subjective improvements, depression criteria according to the Hamilton 17 coefficient, reduction in the amount of pain killers taken, and the side effects produced by the two drugs.

Both groups of patients presented depression criteria, which improved after taking the drugs, without any objective differences between the two forms of therapy, although the subjective feeling of improvement was greater with mirtazapine. In both groups there was a significant reduction in the usual consumption of analgesics after the prophylaxis. Side effects with both antidepressants were relatively frequent, but well tolerated, and the most common were a dry mouth and drowsiness. There were significantly fewer in the group of patients treated with mirtazapine than in those who received amitriptyline.

First, depression and CTTH clearly coexist and that there is a certain dysphoric component associated to suffering chronic headache. Second, mirtazapine has proved to be as efficient in the treatment of CTTH as amitriptyline, but has significantly fewer side effects, probably because it acts more selectively on the brain receptors. It could, therefore, be a drug worth considering for use in the prophylaxis of chronic TTH.