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Drugs and stress management together best manage chronic tension headache: Clinical trial proves benefit of combined therapies

Stress management techniques such as relaxation and biofeedback can help treat chronic tension headaches, especially in combination with medicine, according to research funded by the National Institute of Neurological Disorders and Stroke (NINDS). Results of the first placebo-controlled trial comparing medicines alone vs. medicine plus stress management appear in the May 2, 2001, issue of the Journal of the American Medical Association.(1)

Tension-type headaches affect some 2-3 percent of the nations population on a chronic basis, with twice as many women affected as men. Most people use over-the-counter analgesics to treat their headaches but overuse can make the headache worse and unresponsive to treatment. Stress management therapy for headache is a cognitive behavioral approach that teaches people to recognize and manage early headache signs, cope with pain and address stress-generating issues, and possibly prevent headache.

Kenneth Holroyd, Ph.D., of Ohio University in Athens, and colleagues enrolled 203 adults (with a mean of 26 chronic tension headaches a month) in an 8-month trial to study the effectiveness of behavioral and pharmacological therapies for chronic tension headache. Patients were randomly assigned to one of four treatments: tricyclic antidepressant medication (the primary drug therapy for chronic tension-type headaches), placebo, stress management therapy plus placebo, and stress management therapy plus antidepressant medication. Patients recorded headache activity and the use of analgesic and study medications in a daily diary, as well as measures of disability caused by headaches.

According to Dr. Holroyd and his colleagues, three of the four treatments — tricyclic drugs alone, tricyclics plus stress management, and stress management plus placebo — reduced chronic tension-type headache activity, analgesic use, and headache related disability. Combined drug and behavioral therapy produced a clinically signif
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Contact: Paul Girolami or Margo Warren
301-496-5751
NIH/National Institute of Neurological Disorders and Stroke
30-Apr-2001


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