Chronic Tension‐Type Headache, Mood Depression and Serotonin: Therapeutic Effects of Fluvoxamine and Mianserine

Abstract

Forty out-patients affected by chronic tension-type headache were selected according to the diagnostic criteria of International Headache Society (IHS) Headache Classification Committee. In a controlled trial patients received placebo for a four-week baseline period, then they were randomized in double-blind fashion to therapy with mianserine (30-60 mg/day) of fluvoxamine (50-100 mg/day) for another eight-week period. Frequency of headache, pain severity and analgesic consumption were evaluated using a self-monitoring system. Mood depression was evaluated at 0, 4 and 8 weeks by using Zung's Self-Rating Depression Scale and Hamilton Rating Scale for Depression. Both drugs were beneficial in the treatment of chronic tension-type headache. Non-depressed subjects with more severe headache responded best to fluvoxamine, whereas mianserine was more effective in the treatment of depressed patients with moderate headache. These results suggest that central serotoninergic neurotransmission can play a role in the pathophysiology of chronic tension-type headache also in non-depressed patients.

The Efficacy of Selective Serotonin Reuptake Inhibitors for the Management of Chronic Pain

“…7 Manna et al found fluvoxamine was more effective than mianserine in the nondepressed subgroup of patients with more severe headache, while mianserine was more effective in depressed patients with moderate headache. 8 In the management of migraine headaches, Adly et al found those receiving fluoxetine improved without any concomitant change in their Zung Depression scores. 14 In the treatment of painful diabetic neuropathy, Sindrup et al found improvement in patients treated with paroxetine who either were not depressed or did not experience an antidepressant effect as measured by the Beck Depression Inventory.…”

“…13 In Bánk's comparison of fluvoxamine and low-dose amitriptyline, patients experienced similar improvement, but fewer side effects were noted with fluvoxamine. 15 Except Manna et al, 8 no authors stratified for the presence of major depression or analyzed results separately for depressed and nondepressed groups.…”

“…8 Both treatment groups showed significant improvement in headache frequency ( p Ͻ .01), pain severity ( p Ͻ .01), and analgesic use ( p Ͻ .05). Fluvoxamine was more effective than mianserine in the nondepressed subgroup of patients with more severe headache.…”

Depression and Pain Comorbidity

“…Only 4 studies 6,132,137,141 were conducted in a primary care setting, with the remainder situated in pain, psychiatric, and specialty clinics. The intervention arm of each selected study usually involved tricyclic antidepressants, and only 4 studies involved selective serotonin reuptake inhibitors (SSRIs) 135,138,143,145 to assess pain and depression. While most of the studies demonstrated improvement in both pain and depression symptoms, a few of the studies 132,142,147 failed to show symptom relief.…”

Diagnostische und therapeutische Bedeutung von Schmerzsymptomen der Depression

“…Ein überzeugender positiver Effekt der SSRI auf die depressionsbedingten körperlichen Schmerzen konnte bisher nicht nachgewiesen werden, trotz Besserung des psychischen Zustandes unter der SSRI-Therapie [23,24]. Zusätzlich erwiesen sich SSRI als entweder unwirksam oder deutlich weniger wirksam als Trizyklika, SNRI oder Mirtazapin in der Behandlung chronischer Schmerzen anderer Genese.…”