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Variables Associated With the Use of Prophylactic Amitriptyline Treatment in Patients With Tension-type Headache

Palacios-Ceña, Maria, PT, PhD*,†; Wang, Kelun, DDS, PhD; Castaldo, Matteo, PT, PhD†,‡,§; Ordás-Bandera, Carlos, MD; Torelli, Paola, MD; Arendt-Nielsen, Lars, PhD; Fernández-de-las-Peñas, César, PT, PhD*,†

doi: 10.1097/AJP.0000000000000685
Original Articles

Objective: The objective of this study was to investigate differences in clinical, psychological, and psychophysical outcomes according to use of prophylactic medication (amitriptyline) in tension-type headache (TTH).

Methods: In total, 173 individuals with TTH participated. Headache features and symptomatic medication intake were collected with a 4-weeks headache diary at baseline and at 6-months. Burden of headache (Headache Disability Inventory-HDI), sleep quality (Pittsburgh Sleep Quality Index-PSQI), anxiety/depression (Hospital Anxiety and Depression Scale-HADS), and trait/state anxiety levels (State-Trait Anxiety Inventory-STAI) were also assessed at baseline. Pressure pain thresholds (PPT) were assessed over the temporalis, C5-C6 joint, second metacarpal, and tibialis anterior at baseline. Differences between participants taking or not taking prophylactic medication based on self-perceived effectiveness of the medication on headache characteristics were assessed.

Results: In total, 49 (28%) reported taking prophylactic medication for the headaches (amitriptyline: 100%). From these, 11 (23%) reported no effect, 25 (51%) reported moderate effect, and 13 (26%) reported positive effect with medication. Patients taking prophylactic medication had longer headache history, higher frequency of headaches (61% CTTH), higher headache burden, worse quality of sleep, and higher depression than those not taking medication. Prophylactic medication was less effective in patients with generalized pressure pain hyperalgesia. No other significant differences were found.

Conclusions: Prophylactic medication is used by TTH patients with higher headache frequency, higher headache burden, worse sleep quality, and higher depression. Lower effectiveness of prophylactic amitriptyline was associated with widespread pain hyperalgesia.

*Department Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, University Rey Juan Carlos

Neurology Department, Hospital Rey Juan Carlos, Alcorcón, Spain

Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark

Master in Sport Physiotherapy, University of Siena

§Poliambulatorio Fisiocenter, Collecchio (Parma)

Headache Centre, Department of Medicine and Surgery, University of Parma, Italy

M.P.C. and C.F.dl.P.: did the main analyses and interpretation of data. M.C., K.W., and C.O.B.: provided administrative, technical, and material support. L.A.N. and C.F.dl.P.: supervised the study.

The authors declare no conflict of interest.

Reprints: César Fernández-de-las-Peñas, PT, PhD, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain (e-mail:

Received April 15, 2018

Received in revised form July 16, 2018

Accepted July 17, 2018

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