Patients with chronic tension- type headache (CTTH) are the most difficult to treat. Tricyclic antidepressants are the first-line therapeutic agents, but their anticholinergic side effects limit their usage. Selective serotonin reuptake inhibitors (SSRI) with fewer side effects than tricyclic antidepressants have also been used in treatment of CTTH, but the results are conflicting. In this study, prophylactic action of sertraline in treatment of nondepressed patients with CTTH was investigated and compared with amitriptyline in a prospective, randomized, open label, parallel-group study. A 4-week baseline period was followed by a 12-week treatment period with either 50 mg sertraline (n=41 patients) or 25 mg amitriptyline (n=44 patients). Efficacies of treatments were determined by using a headache diary, in which patients recorded the occurrence, number, intensity and duration of headaches in days, analgesic drug consumption and any adverse events. Both drugs reduced headache symptoms and analgesic drug consumptionat the first, second and third months of treatment compared tobaseline values. There was significant superiority ofamitriptyline in the headache symptoms and drug consumptionreductions versus sertraline at the second and third months oftreatment. Side effects were more favorable in thesertraline-treated patients, but dropouts were similar in bothgroups. These results suggest that both drugs were effective inthe treatment of non-depressed patients with CTTH, but incomparison between groups, amitriptyline was more effective thansertraline.
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