Prophylactic treatment of chronic tension-type headache with trigger points: comparison of oral gabapentin and local injection of depomedrol

This study was designed to compare the effectiveness of oral gabapentin and locally injected depomedrol in trigger points (TrPts) of the head of patients suffering from chronic tension type headaches (CTTH). In this study patients with a diagnosis of CTTH who had at least one active trigger point in their scalp were recruited. Patients were randomly divided into two groups: one receiving depomedrol and the other receiving gabapentin. Depomedrol was injected 10 mg per each TrPt up to a total dose of 40 mg in each patient. Gabapentin was initiated with 200 mg/day and was gradually increased to 300-600 mg daily depending on the therapeutic response. Patients were followed for two months and during the study patients were given a headache diary to record the number, duration and intensity of their headaches, these records were compared at baseline one month and two months after the initiation of therapy. Headache Intensity × Duration index showed a significant decrease in both groups. It was however, significantly lower in depomedrol receiving patients at the end of the first 4 weeks (368.13 ± 195.75 Vs. 467.73 ± 203.09, p < 0.05), and the second 4 weeks (165.44 ± 62.75 Vs. 238.68 ± 81.39, p < 0.05). Similar superiority was detectable for intensity, duration and frequency of headaches (p < 0.05). We found trigger point injection with depomedrol to be a more potent prophylactic agent in comparison to daily oral gabapentin.