{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:36:21Z","timestamp":1792265781375,"version":"4.4.0"},"reference-count":51,"publisher":"American Medical Association (AMA)","issue":"17","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2001,5,2]]},"abstract":"\n Context<\/jats:title>\n Chronic tension-type headaches are characterized by near-daily headaches and often are difficult to manage in primary practice. Behavioral and pharmacological therapies each appear modestly effective, but data are lacking on their separate and combined effects.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for chronic tension-type headaches.<\/jats:p>\n <\/jats:sec>\n \n Design and Setting<\/jats:title>\n Randomized placebo-controlled trial conducted from August 1995 to January 1998 at 2 outpatient sites in Ohio.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Two hundred three adults (mean age, 37 years; 76% women) with diagnosis of chronic tension-type headaches (mean, 26 headache d\/mo).<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomly assigned to receive tricyclic antidepressant (amitriptyline hydrochloride, up to 100 mg\/d, or nortriptyline hydrochloride, up to 75 mg\/d) medication (n = 53), placebo (n = 48), stress management (eg, relaxation, cognitive coping) therapy (3 sessions and 2 telephone contacts) plus placebo (n = 49), or stress management therapy plus antidepressant medication (n = 53).<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n Monthly headache index scores calculated as the mean of pain ratings (0-10 scale) recorded by participants in a daily diary 4 times per day; number of days per month with at least moderate pain (pain rating \u22655), analgesic medication use, and Headache Disability Inventory scores, compared by intervention group.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Tricyclic antidepressant medication and stress management therapy each produced larger reductions in headache activity, analgesic medication use, and headache-related disability than placebo, but antidepressant medication yielded more rapid improvements in headache activity. Combined therapy was more likely to produce clinically significant (\u226550%) reductions in headache index scores (64% of participants) than antidepressant medication (38% of participants;\n P<\/jats:italic>\n = .006), stress management therapy (35%;\n P<\/jats:italic>\n = .003), or placebo (29%;\n P<\/jats:italic>\n = .001). On other measures the combined therapy and its 2 component therapies produced similar outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Our results indicate that antidepressant medication and stress management therapy are each modestly effective in treating chronic tension-type headaches. Combined therapy may improve outcome relative to monotherapy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.285.17.2208","type":"journal-article","created":{"date-parts":[[2003,3,18]],"date-time":"2003-03-18T10:05:58Z","timestamp":1047981958000},"page":"2208","source":"Crossref","is-referenced-by-count":367,"title":["Management of Chronic Tension-Type Headache With Tricyclic Antidepressant Medication, Stress Management Therapy, and Their Combination"],"prefix":"10.1001","volume":"285","author":[{"given":"Kenneth A.","family":"Holroyd","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis J.","family":"O'Donnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Stensland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gay 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