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Table 11 Drugs for the preventive treatment of tension-type headache with a level of recommendation I and II

From: Italian guidelines for primary headaches: 2012 revised version

Drug

Dosage (mg)

Level of evidence

Scientific strength of evidence

Clinical effectiveness

Adverse events

Level of recommendation

Comments

Antidepressants

 Amitriptyline

25–75

A

+++

+++

Frequent, not severe

I

Useful in patients with comorbid anxiety, depression, insomnia. Contraindicated in the case of glaucoma and prostatic hypertrophy

 Clomipramine

10–150

B

++

++

Frequent, not severe

II

 

 Fluvoxamine

50–100

B

++

++

Frequent, not severe

II

 

 Maprotilin

75

B

+++

++

Frequent, not severe

II

 

 Mianserin

30–60

A

++

+

Frequent, not severe

II

 

 Mirtazapine

15–30

A

+++

+++

Frequent, not severe

I

Particularly indicated in patients with anxiety, depression, insomnia. It may induce somnolence

 Venlafaxine

75–150

B

++

++

Frequent, not severe

II

 

Muscle relaxants

 Tizanidine oral

3–12

B

+++

+++

Frequent, not severe

II

Especially useful in the case of pericranial muscle tenderness

Benzodiazepines

 Diazepam

5

B

++

++

Occasional, not severe

II

 

Other drugs

 Topiramate oral

25–100

C

+++

+++

Frequent, not severe. Rarely severe

II