They're Thinking About "Euphorizing" You Chronic Soreheads

"Isn't it interesting," thinks a long suffering patient, " how doctors always seem to find a way to blame me whenever they can't make the diagnosis, or fail to get results with their medications?" This is especially true when there are only symptoms, and no signs of any disease found during a physical exam, or later from laboratory tests? The classic example of a symptom with innumerable possible causes that are extremely difficult to root out is the persistent headache. The classic example of how to blame the patient is to dig down slightly into deep diagnostic muck and pull out "chronic tension-type headache." This diagnosis is a godsend for some harried physicians who would rather shift the blame in the direction of those miserable, complaining wrecks than spend any more time investigating further. So, whenever a research study targets a new way to treat chronic tension-type headache suspicion immediately arises as to how they knew the headaches were really due to stress.

A group of researchers, funded by the National Institute of Neurological Disorders and Stroke from the National Institutes of Health of the United States and led by a PhD named Holyroyd, published an article called "Management of Chronic Tension-Type Headache with Tricyclic Antidepressant Medication, Stress Management, and Their Combination" in the prestigious JAMA (formerly Journal of the American Medical Association). Their criteria for diagnosing chronic tension-type headache was evidently derived from recognized books such as "The Headaches" and several manuscripts published by Oleson and colleagues, as well as various other articles directly or indirectly related to their topic. The results of their study led to the conclusion that this was the first placebo-controlled trial utilizing behavioral and drug therapies, either separately or combined, to combat tension headaches, and that both of the medications used, amitriptyline hydrochloride and nortriptyline hydrochloride, were effective. Apparently, when compared to placebo, each drug produced significantly larger reductions in headache activity, in the use of pain pills, and in disability due to headaches. This was most evident for headache activity, which faded more rapidly. Furthermore, combining the two medications with stress management was even better, since this approach was more likely to produce clinically significant improvement than any of the other separate approaches.

Although the results appear to be encouraging, a later commentary by Rifkin and Ward in JAMA challenged the study because patients who have such chronic tension-type headaches also tend to have other psychiatric disorders that might have responded to the two antidepressants. This would appear to negate the conclusion that the drugs had any direct effect on the headaches themselves. In other words, what came first, the chicken or the egg?

Objections to the use of such antidepressants could be taken one step further because some of the rather prevalent side effects of the two drugs might readily turn off the average patient who, already under stress, would be likely object to such things as dry mouth, drowsiness, weight gain, dizziness, sweating, constipation, abdominal pains, nervousness or increased appetite.

Shall we also question, as well, whether getting rid of depressing thoughts and replacing them with euphoric ones is the way to solve our problems, especially when the method involves using drugs? On the other hand, perhaps the average individual suffering from constantly recurring headaches might be inclined to accept any alternative symptoms or medication if only the pain would go away for a while.