Intra-oral orthosis vs amitriptyline in chronic tension-type headache: a clinical and laser evoked potentials study

Marina de Tommaso, Elliott Shevel, Carla Pecoraro, Michele Sardaro, Daniela Divenere, Olimpia Di Fruscolo, Paolo Lamberti, Paolo Livrea, Marina de Tommaso, Elliott Shevel, Carla Pecoraro, Michele Sardaro, Daniela Divenere, Olimpia Di Fruscolo, Paolo Lamberti, Paolo Livrea

Abstract

Background: In the present study, we examined clinical and laser-evoked potentials (LEP) features in two groups of chronic tension-type headache (CTTH) patients treated with two different approaches: intra-oral appliance of prosthesis, aiming to reduce muscular tenderness, and 10 mg daily amitriptyline.

Methods: Eighteen patients with diagnosed CTTH participated in this open label, controlled study. A baseline evaluation was performed for clinical features, Total Tenderness Score (TTS) and a topographic analysis of LEPs obtained manually and the pericranial points stimulation in all patients vs. healthy subjects. Thereafter, patients were randomly assigned to a two-month treatment by either amitriptyline or intra-oral appliance.

Results and discussion: Both the intra-oral appliance and amitriptyline significantly reduced headache frequency. The TTS was significantly reduced in the group treated with the appliance. The amplitude of P2 response elicited by stimulation of pericranial zones showed a reduction after amitriptyline treatment.Both therapies were effective in reducing headache severity, the appliance with a prevalent action on the pericranial muscular tenderness, amitriptyline reducing the activity of the central cortical structures subtending pain elaboration

Conclusion: The results of this study may suggest that in CTTH both the interventions at the peripheral and central levels improve the outcome of headache.

Figures

Figure 1
Figure 1
An example of oral appliance before (upper) and after (lower) adjustement.
Figure 2
Figure 2
Clinical Features of chronic tension type headache patients. Mean values and standard deviations of the main clinical features, frequency of headache, Total Tenderness Score (TTS), Self Evaluating Anxiety Scale (SAS) and Self Evaluating Depression Scale (SDS) in chronic tension type headache in basal conditions (T0) and after two months treatment (T1) by appliance (n°9 patients) and amitriptyline (n°9 patients).
Figure 3
Figure 3
Laser evoked potentials in chronic tension type headache patients. Grand average of LEPs across 9 chronic tension type headache patients assigned to amitriptyline and 9 assigned to the oral appliance in basal conditions (T0) and after two months treatment (T1). The amitriptyline induced a reduction of the later positive wave, the P2.

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