Comparison of the Effectiveness of Pharmacotherapy and Cognitive-Behavioral Stress Management and Their Combination on Distress Tolerance and Headache Reduction in Patients with Tension Headache

Tension headaches are the most common type of headache which lead to functional decline in patients with this problem. Considering the fact that pharmacotherapy alone cannot be a complete treatment for this problem, the present study was conducted to evaluate the effectiveness of cognitive-behavioral stress management alone and along with pharmacotherapy on the treatment of tension headaches.

In this cross-sectional study, 40 patients with tension headache were selected by convenience sampling method and were divided into four groups of ten. The first group received stress management program, the second group underwent pharmacotherapy, the third group was under pharmacotherapy and stress management, and the fourth group received no treatment. Subjects were treated for eight weeks and they completed Distress Tolerance Scale (DTS) and Tension Headache Questionnaire before and after the intervention and the results were compared.

Mean distress tolerance scores in the first group changed from 41.50±8.38 to 46.50±9.05, the second group from 42.43±7.18 to 42.00±7.46, the third group from 37.00±9.73 to 45.75±9.25 and the fourth group changed from 40.86±9.61 to 38.43±9.67 (p=0.000). Headache severity in the first group changed from 7.50±2.07 to 4.75±1.48, the second group from 7.14±1.95 to 4.57±1.90, the third group from 6.75±2.81 to 2.25±1.66 and the fourth group changed from 6.86±1.95 to 7.71±2.13 (p=0.00). Pairwise comparison of the groups demonstrated that the third group (combination therapy) showed a significant difference in both variables compared to other groups (p=0.04).

The results of the study demonstrated that combination therapy (cognitive-behavioral stress management and pharmacotherapy) showed the greatest effect on distress tolerance and headache reduction. Therefore, stress management can be a suitable complement to medication.