This randomized controlled trial compared the effectiveness of spinal manipulation and amitriptyline for the treatment of chronic tension-type headache. This study consisted of a 2 week baseline period, a 6 week treatment period and a 4 week post-treatment follow-up period. Of the 150 patients who were enrolled in the study, 24 (16%) dropped out, 5 (6.6%) from the spinal manipulative therapy and 19 (27%) from the amitriptyline group. During the treatment period both groups improved at very similar rates in all primary outcomes. In relationship to baseline values at four weeks after cessation of treatment, the spinal manipulation group showed: a 32% reduction in headache intensity, a 37% reduction in headache frequency, a 37% reduction in over-the-counter medication usage, and a 16% improvement in functional health status. The amitriptyline group showed improvement from baseline values in the same four major outcome measures of 6% or less. Controlling for baseline differences, all group differences at four weeks after cessation of therapy were considered to be clinically important and were statistically significant. This sustained therapeutic benefit may reduce the need for self-administered analgesic medication. There is a need to assess the effectiveness of spinal manipulative therapy beyond four weeks and to compare spinal manipulative therapy to an appropriate placebo such as sham manipulation in future clinical trials. Boline, DC. APT 1995;18(3):148-15. PAGE TOP