Phenelzine therapy for headache patients with concomitant depression and anxiety

Eleven patients with refractory chronic daily headache, associated depression, and generalized anxiety were treated with phenelzine. Ten patients (91%) had a greater than or equal to 50% improvement in headache frequency, seven (64%) had a similar degree of improvement in mood and headache intensity or activity level. Orthostatic hypotension was the most common side effect and necessitated discontinuation of therapy in two patients. One patient suffered a hypertensive crisis which was easily managed and caused no permanent sequelae. Based on these preliminary results, we conclude that phenelzine is effective in the treatment of chronic daily headache with associated depression and anxiety, but further investigations are needed to determine if there is selective efficacy of phenelzine for this subgroup of patients.