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Jewish World Review May 2, 2001 / 9 Iyar, 5761

Lee Bowman

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Consumer Reports

Cutting chronic tension headaches -- RESEARCHERS have found that a combination of stress-management therapy and an anti-depressant drug can cut the frequency of chronic tension headaches by half.

The approach could offer relief to millions of Americans who suffer from the debilitating headaches almost daily, according to researchers at Ohio University in Athens, Ohio.

Writing in the latest edition of The Journal of the American Medical Association, out Wednesday, the researchers said that while low daily doses of the anti-depressant amitriptyline or stress-management therapy each helped about one-third of the patients they studied, the combined effect was much better.

"About two-thirds of the participants receiving combined therapy showed at least a 50 percent reduction in headaches,'' said Ken Holroyd, a professor of psychology at Ohio who led the study under a grant from the National Institute of Neurological Disorders and Stroke.

"These are people who are having pain almost daily, so this significantly improves daily life for them even if it doesn't eliminate headaches altogether,'' Holroyd added.

Regular or chronic tension-type headaches are thought to affect between 2 percent and 3 percent of the population. They have the episodes at least 15 days each month. The pain or dull ache strikes both sides of the head and neck - many sufferers say the pressure feels like their head's in a vise.

Scientists still aren't sure what triggers this type of headache, but know the cause is different from other kinds of headache.

"With chronic tension headaches, the sensitivity of circuits that transmit pain signals to the brain get turned up, much like you might turn up a radio,'' Holroyd said. "So the same pain signal is louder or more painful when it is transmitted to the brain.''

The 203 people in the Ohio study were patients at clinics in Athens and Columbus who were having headaches an average of 26 days a month.

They were randomly assigned to receive a placebo drug, amitriptyline, stress-management therapy or a combination of the prescription drug and stress therapy.

All participants visited the clinics monthly for three months. Stress-management skills were taught and the dose of anti-depressant medication was adjusted at each visit. The stress-management patients also got manuals and audiotapes to practice their skills at home.

The patients all kept diaries of the frequency and severity of headaches and their use of pain medications. Those getting the anti-depressant alone recorded faster headache relief than those getting just stress-management treatment. But that latter group showed equal improvement over time as patients learned to identify warning signs that a headache was coming, preventing their headaches and reducing their need for medications.

"Generally, there is an effort to taper off the anti-depressant after six months to a year,'' Holroyd said. "We followed people in this study for a year after their participation ended and people who received the combination treatment were more likely than people who got the medication alone to successfully discontinue taking the anti-depressant.''

For many people with chronic tension headaches, taking pain relievers causes what Holroyd terms a "rebound effect.

"When you take pain-relieving medication regularly, your body adjusts to that level of medication. Rebound headaches may then occur between medication doses or if you don't take the medication.

"For some people, this can be a cyclical problem. They take medication for a headache, get more headaches, take more medication and so on. This cycle has to be broken before their headaches can really be treated,'' Holroyd said.

Amitriptyline and other anti-depressants in a class of drugs called tricyclics don't produce such a rebound effect, Holroyd said. Amitriptyline is also sold under brand names like Elavil, Etrafon and Limbitrol. Although scientists don't know exactly how the anti-depressants reduce pain, they believe that the drugs somehow dampen the sensitivity of circuits that transmit pain signals to the brain.

Holroyd's lab is now working on a new, five-year study of migraine-headache sufferers to see if some of the same techniques will help them.

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