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Review: antidepressants improve headache in patients with chronic headache

Data sources
Studies were identified by searching Medline (1966 to December 1998), PsycLIT (1974 to December 1998), EMBASE/Excerpta Medica (1974 to December 1998), and the Cochrane Library. Bibliographies of relevant articles were reviewed, and Federal Research in Progress was searched for information on unpublished trials.

Study selection
Studies in any language were selected if they were randomised controlled trials (RCTs) comparing the effectiveness of antidepressants with placebo in patients with chronic headache and if measurable outcomes were reported.

Data extraction
Data were extracted on setting, country of origin, patient inclusion and exclusion criteria, sample size, demographical characteristics, comorbid psychiatric disease, concurrent use of analgesic medications, key components of the intervention, study quality, adverse effects, and outcomes. Outcomes were overall improvement in headache (> 50% reduction in Headache Index scores, global improvement based on > 50% improvement, impression of improvement, or headache frequency or severity) and effect size of treatment (measured in standard deviation units) on . . . [Full text of this article]

Robert Badgett, MD

University of Texas Health Sciences Center San Antonio, Texas, USA