The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 15 Supplement 1

Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014

Open Access

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

  • Y Ezra1,
  • M Gotkine2,
  • S Goldman3,
  • HM Adahan4 and
  • T Ben-Hur5
The Journal of Headache and Pain201415(Suppl 1):I3

Published: 18 September 2014


Standard LengthAmitriptylineBehavioral InterventionTreatment ComplianceHeadache Frequency


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.

Authors’ Affiliations

Neurology, Soroka University Medical Center, Beer Sheva, Israel
Neurology, Hadassah University Medical Center, Jerusalem, Israel
Internal medicine, Hadassah University Medical Center, Jerusalem, Israel
Pain Rehabilitation, Shiba Medical Center, Ramat Gan, Israel
Neurology, Hadassah University Medical Center, Jerusalem, Israel


© Ezra et al; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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