Higher headache frequency, higher headache burden, worse sleep quality, and higher depression found to be associated with amitriptyline as prophylactic medication used by tension-type headache (TTH) patients, explained in study results in the 'The Clinical Journal of Pain'.

Palacios-Ceña M et al. investigated the differences in the clinical, psychological and psychophysical outcomes with the use of prophylactic medication amitriptyline in TTH.

A total of 173 patients with TTH participated in this study. At the baseline and 6-months, the headache features and symptomatic medication intake were collected with a 4-weeks headache diary. At the baseline, sleep quality (Pittsburgh Sleep Quality Index-PSQI), headache burden (Headache Disability Inventory-HDI), anxiety/depression (Hospital Anxiety and Depression Scale-HADS), and trait/state anxiety levels (State-Trait Anxiety Inventory-STAI) were examined. Also, the pressure pain thresholds (PPT) were observed over the temporalis, C5-C6 joint, second metacarpal, and tibialis anterior. The differences between subjects taking or not taking prophylactic medication as per the self-perceived effectiveness of the medicines on headache characteristics were investigated.

It was found that 49 (28%) reported taking prophylactic medication, amitriptyline: 100% for the headaches. From these, 11 (23%) showed no effect, 25 (51%) showed a moderate effect, and 13 (26%) showed a positive impact due to the medication intake. The patients taking prophylactic medication had longer headache history, higher frequency of headaches (61% CTTH), higher headache burden, worse quality of sleep, and higher depression as compared to those not taking medication. The prophylactic medication was least effective in patients suffering from generalized pressure pain hyperalgesia. There were no other significant differences.

"Lower effectiveness of prophylactic amitriptyline was associated with a widespread pain hyperalgesia", summarized the study authors.