Association of escitalopram prophylaxis with pain intensity in tension-type headache: A retrospective, comparative cohort study.

Abstract

Background: This study aims to evaluate the association between escitalopram prophylaxis and pain intensity in patients with tension-type headache.

Patients and methods: This retrospective, comparative cohort study included a total of 503 patients between July 1st, 2022 and October 1st, 2022. The patients were divided into two groups according to their treatment approach. The first group (Group 1, n = 300) consisted of patients who initiated escitalopram prophylaxis. The second group (Group 2, n = 203) consisted of patients who did not receive prophylactic treatment and were monitored with symptomatic treatment. Pain intensity was assessed using the Visual Analog Scale (VAS) at baseline and after approximately three months. Between-group changes were compared, and follow-up VAS scores were evaluated using regression models adjusted for baseline VAS, age and sex. The Headache Screening Questionnaire (HSQ) findings were considered exploratory.

Results: Of a total of 503 patients, 159 were male and 344 were female with a mean age of 33.00 ± 3.44 (range, 22 to 46) years. The groups were similar in age and sex distribution, although baseline VAS scores were higher in the escitalopram group. The mean VAS scores decreased from 5.06 ± 1.23 to 4.55 ± 1.17 in the escitalopram group and increased from 4.68 ± 1.40 to 4.92 ± 1.41 in the symptomatic treatment group. The difference in change between groups was significant. Escitalopram use remained associated with lower follow-up VAS scores after adjustment for baseline VAS, age and sex. The HSQ findings were exploratory and were not interpreted as confirmatory evidence of treatment efficacy.

Conclusion: Escitalopram prophylaxis was associated with lower pain intensity after approximately three months. As treatment allocation was non-randomized and baseline pain severity differed between groups, the findings should be interpreted cautiously. Escitalopram warrants further investigation in patients who cannot tolerate or are unsuitable for first-line prophylactic treatments.