Comparative Effectiveness of Drugs in the Treatment of Primary Headache

Introduction: Primary headache disorder, characterized by recurrent headache is the most prevalent disease leading to widespread ill health and impaired quality of life. Headache is one of the most common cause of patient attending neurology clinic. Amitriptyline, flunarizine and topiramate are common drugs in the treatment of primary headache. Objective: To compare the efficacy of drugs namely Amitriptyline, flunarizine and topiramate in the treatment of primary headache. Methods and Materials: This is the retrospective data analysis study was contacted at Dept. Of Neurology, Enam Medical College Hospital, Savar, Dhaka, Bangladesh from March to June 2022. Data analysis of primary headache patients treated with amitriptyline, flunarizine and topiramate. On their first, second and third subsequent visits, Headache Impact Test 6 Scoring was done by a medical person. Patients were treated clinically. After the third follow up data were analyzed using SPSS version 20.0. Categorical variables were compared by chi-square test, paired sample t-test, ANOVA test and Welch test. Results: A total of 121 patient data was analyzed. Most patients were between 16 to 40 years of age (54.34%) followed by 41-60 years of age (33.80%) with minimum age of 16 years and maximum age of 60 years respectively. Among the patients in the study group, the majority were female (85%). All three medications: amitriptyline, flunarizine and topiramate were able to significantly lower Headache impact test -17.23 ± 6.643, -14.06 ± 7.155, -15.82 ± 5.907 respectively (P-<0.001). Amitriptyline was found to be better than other two drugs in reducing Headache Impact Test. Conclusion: Primary headache is a common presentation in neurological OPD. Female between ages 16-60 years had more primary headache. Amitriptyline, flunarizine and topiramate all are effective in the treatment of primary headache. Though tension type of headache is the most common type of headache, amitriptyline seems to be equally effective in treatment with other primary headaches.