Antidepressants for Migraine Prophylaxis

Lampl C, Schweiger C.  Antidepressants for Migraine Prophylaxis.  European Neurological Journal, June 2010; 2(1):  83-87

Review article


Christian Lampl and Christine Schweiger

Affiliation: Department of Neurology and Pain Medicine, Konventhospital Barmherzige Bru¨der Linz, Linz, Austria


ABSTRACT

The objectives of this review are to provide a comprehensive critical analysis of published reports of randomized controlled trials of antidepressants for reducing headache burden among adults with migraine, and to determine whether efficacy varies according to important patient characteristics, such as coexisting depression. The mechanism whereby amitriptyline and other antidepressants produce their analgesic effects is unknown, but the blockade of serotonin and norepinephrine re‐uptake has been hypothesized to play a pivotal role. Concerning amitriptyline, there is some evidence that this tricyclic antidepressant may be beneficial in the prophylaxis of migraine in some patients. For selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), beneficial effects are equivalent to those seen in the placebo group within 2 months of therapy. To conclude, there is limited evidence for a clinical superiority of amitriptyline and SSRIs over other treatments with ß‐blockers, anticonvulsants, or calcium channel blockers in preventing migraine. Antidepressants in migraine should be considered if other first‐ or second‐line drugs have not reduced the number of monthly attacks or if concomitant depression exists. Therefore, antidepressants are second‐ or (even) third‐line prophylactic agents in patients with migraine alone.

Keywords: Migraine, antidepressants, prophylactic treatment, SSRIs, SNRIs
Correspondence: Christian Lampl, Department of Neurology and Pain Medicine, Konventhospital Barmherzige Brüder Linz, Seilerstätte 2, Linz, Austria. Tel: (43)‐732‐780‐625320; Fax: (43)‐732‐780‐625398; e‐mail: christian.lampl@bblinz.at