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Table 12 Prophylactic drugs with some evidence of efficacy in frequent episodic or chronic tension-type headache

From: Aids to management of headache disorders in primary care (2nd edition)

Amitriptyline, 10–100 mg at night • Drug of choice for frequent episodic or chronic TTH;
• Intolerance is reduced by starting at a low dose (10 mg) and incrementing by 10–25 mg each 1–2 weeks
Nortriptyline (replacing amitriptyline at the same dose) • Fewer anticholinergic side-effects but less good evidence of efficacy
Mirtazapine, 15–30 mg once daily • Second-line option
Venlafaxine, 75–150 mg once daily • Third-line option