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 1^st, 2022 and October 1^st, 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.

Cite this article as: Elbeyli AB, Tak AZA. Association of escitalopram prophylaxis with pain intensity in tension-type headache: A retrospective, comparative cohort study. Agri 2026;38(4):264-271. doi: 10.5606/agri.2026.170.

A.B.E., A.Z.A.T.: Idea/concept, design, analysis and/or interpretation, critical review; A.Z.A.T.: Control/supervision; A.B.E.: Data collection and/or processing, literature review, writing the article, references and fundings, materials.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.