TY - JOUR
T1 - Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache
AU - Bendtsen, Lars
AU - Jensen, Rigmor
PY - 2004/5/25
Y1 - 2004/5/25
N2 - BACKGROUND: The tricyclic antidepressant amitriptyline is the only drug with prophylactic efficacy for chronic tension-type headache. However, amitriptyline is only moderately effective, with headache reduction of approximately 30%, and treatment is often hampered by side effects. Mirtazapine is a relatively new so-called noradrenergic and specific serotonergic antidepressant, which is more specific and therefore generally better tolerated.OBJECTIVE: To evaluate the efficacy of mirtazapine.METHODS: Twenty-four nondepressed patients with chronic tension-type headache were included in a randomized, double-blind, placebo-controlled, crossover trial. All patients had tried numerous other treatments. Mirtazapine 15 to 30 mg/day or placebo was each given for 8 weeks separated by a 2-week wash-out period.RESULTS: Twenty-two patients completed the study. The primary efficacy variable, area-under-the-headache curve (AUC; duration x intensity), was lower during treatment with mirtazapine (843) than during treatment with placebo (1,275) (p = 0.01). Mirtazapine also reduced the secondary efficacy variables headache frequency (p = 0.005), headache duration (p = 0.03), and headache intensity (p = 0.03) and was well tolerated.CONCLUSIONS: Mirtazapine reduced AUC by 34% more than placebo in difficult-to-treat patients. This finding is clinically relevant and may stimulate the development of prophylactic treatments with increased efficacy and fewer side effects for tension-type headache and other types of chronic pain.
AB - BACKGROUND: The tricyclic antidepressant amitriptyline is the only drug with prophylactic efficacy for chronic tension-type headache. However, amitriptyline is only moderately effective, with headache reduction of approximately 30%, and treatment is often hampered by side effects. Mirtazapine is a relatively new so-called noradrenergic and specific serotonergic antidepressant, which is more specific and therefore generally better tolerated.OBJECTIVE: To evaluate the efficacy of mirtazapine.METHODS: Twenty-four nondepressed patients with chronic tension-type headache were included in a randomized, double-blind, placebo-controlled, crossover trial. All patients had tried numerous other treatments. Mirtazapine 15 to 30 mg/day or placebo was each given for 8 weeks separated by a 2-week wash-out period.RESULTS: Twenty-two patients completed the study. The primary efficacy variable, area-under-the-headache curve (AUC; duration x intensity), was lower during treatment with mirtazapine (843) than during treatment with placebo (1,275) (p = 0.01). Mirtazapine also reduced the secondary efficacy variables headache frequency (p = 0.005), headache duration (p = 0.03), and headache intensity (p = 0.03) and was well tolerated.CONCLUSIONS: Mirtazapine reduced AUC by 34% more than placebo in difficult-to-treat patients. This finding is clinically relevant and may stimulate the development of prophylactic treatments with increased efficacy and fewer side effects for tension-type headache and other types of chronic pain.
KW - Adrenergic alpha-2 Receptor Antagonists
KW - Adrenergic alpha-Antagonists/adverse effects
KW - Adult
KW - Area Under Curve
KW - Chronic Disease
KW - Cross-Over Studies
KW - Dizziness/chemically induced
KW - Double-Blind Method
KW - Female
KW - Humans
KW - Male
KW - Mianserin/adverse effects
KW - Middle Aged
KW - Mirtazapine
KW - Neurotransmitter Agents/metabolism
KW - Pain Measurement
KW - Receptors, Presynaptic/antagonists & inhibitors
KW - Tension-Type Headache/drug therapy
KW - Treatment Outcome
KW - Weight Gain/drug effects
U2 - 10.1212/01.wnl.0000127282.90920.8c
DO - 10.1212/01.wnl.0000127282.90920.8c
M3 - Journal article
C2 - 15159466
SN - 0028-3878
VL - 62
SP - 1706
EP - 1711
JO - Neurology
JF - Neurology
IS - 10
ER -