Summary of findings for the main comparison. SSRIs or SNRIs versus placebo for tension‐type headache.
| SSRIs or SNRIs compared to placebo for tension‐type headache | ||||||
| Patient or population: patients with tension‐type headache Intervention: SSRIs or SNRIs Comparison: placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo | SSRIs or SNRIs | |||||
|
Headache frequency
(number of days with headache) Follow‐up: 2 months |
The mean headache frequency ranged across control groups from 13.8 to 21.7 days with headache | The mean headache frequency in the intervention groups was 0.96 lower (3.95 lower to 2.03 higher) | 127 (2 studies) | ⊕⊕⊝⊝ low1 | ||
|
Headache intensity
(score) Follow‐up: 2 months |
The mean headache severity in the control groups was 3.9 | The mean headache severity in the intervention groups was 0.30 lower (1.13 lower to 0.53 higher) | 40 (1 study) | ⊕⊕⊝⊝ low1 | ||
|
Headache duration
(hours) Follow‐up: 2 months |
The mean headache duration in the control groups was 6.57 | The mean headache duration in the intervention groups was 0.07 lower (2.69 lower to 2.55 higher) | 40 (1 study) | ⊕⊕⊝⊝ low1 | ||
|
Symptomatic/analgesic medication for acute headache attacks
(doses/month) Follow‐up: 2 months |
The mean symptomatic/analgesic medication for acute headache attacks ranged across control groups from 1.07 to 34.8 doses | The mean symptomatic/analgesic medication for acute headache attacks in the intervention groups was 1.87 lower (2.09 to 1.65 lower) | 118 (2 studies) | ⊕⊕⊝⊝ low1 | This finding is largely driven by the results reported by a study at high risk of sponsorship bias | |
|
Headache index Follow‐up: 2 months |
The mean headache index ranged across control groups from 18.3 to 877 | The mean headache index in the intervention groups was 0.24 SDs lower (0.59 lower to 0.11 higher) | 128 (2 studies) | ⊕⊝⊝⊝ very low2 | As a rule of thumb, 0.2 SDs represents a small difference, 0.5 moderate and 0.8 large (Cohen 1988) | |
| Quality of life | See comment | See comment | Not estimable | ‐ | See comment | Not measured |
|
Withdrawals due to adverse events Follow‐up: 2 months |
Study population | OR 3.72 (0.79 to 17.53) | 190 (3 studies) | ⊕⊝⊝⊝ very low3 | ||
| 11 per 1000 | 40 per 1000 (9 to 163) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio; SD: Standard deviation; SNRI: Serotonin‐norepinephrine reuptake inhibitor; SSRI: selective serotonin reuptake inhibitor | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Limitations in study design, imprecision (insufficient data). 2 Limitations in study design, imprecision (insufficient data), indirectness (lack of generalisability). 3 Limitations in study design, imprecision (insufficient data), inconsistency (heterogeneity).