A comparison of pharmacological (amitriptyline HCL) and nonpharmacological (cognitive-behavioral) therapies for chronic tension headaches.

Abstract

Forty-one recurrent tension headache sufferers were randomly assigned to either cognitive-behavioral therapy (administered in a primarily home-based treatment protocol) or to amitriptyline therapy (with dosage individualized at 25, 50, or 75 mg/day). Cognitive-behavioral therapy and amitriptyline each yielded clinically significant improvements in headache activity, both when improvement was assessed with patient daily recordings (56% and 27% reduction in headache index, respectively), and when improvement was assessed with neurologist ratings of clinical improvement (94% and 69% of patients rated at least moderately improved, respectively). In instances where differences in treatment effectiveness were observed (headache index, somatic complaints, perceptions of control of headache activity), cognitive-behavioral therapy yielded somewhat more positive outcomes than did amitriptyline. Neither treatment, however, eliminated headache problems.

Systematic review of cognitive behavioural therapy for the management of headaches and migraines in adults

“…Four of the studies had one comparator (Basler et al, 23 Holroyd et al, 17 Martin et al, 24 Tobin et al 19 ), three had two comparators (Martin et al, 26 Mosley et al, 18 Richardson and McGrath 25 ) and the remaining three studies had four comparators (Blanchard et al, 16 Blanchard et al, 20 Holroyd et al 21,22 ). Other active treatment comparators included relaxation in three studies (Blanchard et al, 16 Mosley et al, 18 Tobin et al 19 ), and one study each of combined relaxation with biofeedback (Blanchard et al 20 ), combined CBT with antidepressants (Holroyd et al 21,22 ), antidepressants (Holroyd et al 17 ) and biofeedback (Martin et al 26 ).…”

“…Of the 10 included studies, six employed mixed interventions (see Table 1), of which four studies combined some form of CBT with relaxation (Blanchard et al, 16 Holroyd et al, 17 Mosley et al, 18 Tobin et al 19 ), one with biofeedback (Blanchard et al 20 ) and the remaining study with placebo (Holroyd et al 21,22 ). In addition, one study allowed additional physical treatments such as pain medication, nerve blocks, acupuncture, massage and physical therapy for both the CBT and the wailing list control group (Basler et al 23 ).…”

“…Other active treatment comparators included relaxation in three studies (Blanchard et al, 16 Mosley et al, 18 Tobin et al 19 ), and one study each of combined relaxation with biofeedback (Blanchard et al 20 ), combined CBT with antidepressants (Holroyd et al 21,22 ), antidepressants (Holroyd et al 17 ) and biofeedback (Martin et al 26 ). Relaxation and biofeedback could therefore be part of the intervention or a comparator, making comparison between studies difficult.…”

“…The most complete results were reported for 3 months post-treatment in three studies 21,23,25 and 6 months in seven studies. [16][17][18][19][20]24,26 …”

eHealth cognitieve gedragstherapie voor patiënten met chronische somatische aandoeningen

“…1 CGt wordt ook steeds vaker ingezet om het groeiende aantal patiënten met chronische somatische aandoeningen te ondersteunen, bijvoorbeeld door mensen met pijngerelateerde aandoeningen beter te leren omgaan met pijn en beperkingen, of door veelvoorkomende bijkomende stemmings-of vermoeidheidsklachten te behandelen bij mensen met reuma, diabetes of kanker. [1][2][3][4][5][6] Hoewel uit onderzoek blijkt dat CGt ook effectief kan zijn bij deze patiëntgroepen, is het tot op heden nog niet op grote schaal geïmplementeerd, gedeeltelijk vanwege het gebrek aan CGt-therapeuten gespecialiseerd in de behandeling van deze patiënten. Daarnaast kunnen patiën-ten lichamelijke beperkingen hebben waardoor het lastig voor ze is om naar een ziekenhuis te komen voor reguliere CGt.…”