Skip to main content

EHMTI-0395. Hypnotic relaxation vs amitriptyline for tension-type headache: let the patient choose


Although both pharmacological and behavioral interventions may relieve tension-type headache, data are lacking regarding treatment preference, compliance, and feasibility of behavioral intervention in a neurological outpatient clinic setting.


To describe patient choice, compliance, and outcome in a neurological clinic where patients are given the choice of the approach they wish to pursue.


Patients presenting to the headache clinic with a diagnosis of tension-type headache, were given the choice of amitriptyline (AMT) treatment or hypnotic relaxation (HR), and were treated accordingly. Patients were given the option to cross-over to the other treatment group . HR was performed during standard length neurology clinic appointments by a neurologist . Follow-up interviews were performed between 6 and 12 months following treatment initiation to evaluate compliance, headache frequency or severity, and quality-of-life.


98 patients were enrolled, 92 agreed to receive prophylactic therapy. 53 (57.6%) patients chose HR of which 36 (67.9%)initiated this treatment, 39 (42.4%) chose AMT of which 25 (64.1%) initiated therapy. 74%of the patients in the HR group and 58% of patients in the AMT group had a 50% reduction in the frequency of headaches (P=.16). At the end of the study , 26 patients who tried HR compared with 10 who tried AMT continued receiving their initial treatment.


HR was a more popular choice among patients. Patients choosing HR reported greater amelioration than those choosing AMT and were found to have greater treatment compliance. HR practiced by a neurologist is feasible in a standard neurological outpatient clinic.

No conflict of interest.

Author information



Corresponding author

Correspondence to Y Ezra.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ezra, Y., Gotkine, M., Goldman, S. et al. EHMTI-0395. Hypnotic relaxation vs amitriptyline for tension-type headache: let the patient choose. J Headache Pain 15, I3 (2014).

Download citation

  • Published:

  • DOI:


  • Standard Length
  • Amitriptyline
  • Behavioral Intervention
  • Treatment Compliance
  • Headache Frequency