Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache.

Abstract

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.

• Authors: Lars Bendtsen, Rigmor Jensen
• Journal: Neurology (Neurology) Vol. 62 Issue 10 Pg. 1706-11 (May 25 2004) ISSN: 1526-632X [Electronic] United States
• PMID: 15159466 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Adrenergic alpha-2 Receptor Antagonists
• Adrenergic alpha-Antagonists
• Neurotransmitter Agents
• Receptors, Presynaptic
• Mianserin
• Mirtazapine

Topics

• Adrenergic alpha-2 Receptor Antagonists
• Adrenergic alpha-Antagonists (adverse effects, therapeutic use)
• Adult
• Area Under Curve
• Chronic Disease
• Cross-Over Studies
• Dizziness (chemically induced)
• Double-Blind Method
• Female
• Humans
• Male
• Mianserin (adverse effects, analogs & derivatives, therapeutic use)
• Middle Aged
• Mirtazapine
• Neurotransmitter Agents (metabolism)
• Pain Measurement
• Receptors, Presynaptic (antagonists & inhibitors)
• Tension-Type Headache (drug therapy)
• Treatment Outcome
• Weight Gain (drug effects)