Tricyclics for prophlyaxis of migraines and tension headaches

January 01, 0001

Tricyclics for prophlyaxis of migraines and tension headaches

These US researchers tested the efficacy and adverse effects of tricyclic antidepressants in the prevention of migraine, tension-type, and mixed headaches. They performed a systematic review with meta-analysis, searching Medline, Embase, the Cochrane Trials Registry, and PsycLIT. Thirty seven randomized trials of adults receiving tricyclics were included. Number of attacks for migraine headaches and number of days with headache for tension-type headaches were extracted, along with intensity of headache and headache index.

The researchers found: "Tricyclics significantly reduced the number of days with tension-type headache and number of headache attacks from migraine than placebo (average standardised mean difference -1.29 and -0.70) but not compared with selective serotonin reuptake inhibitors (-0.80 and - 0.20). The effect of tricyclics increased with longer duration of treatment. Tricyclics were also more likely to reduce the intensity of headaches by at least 50% than either placebo (tension-type: relative risk 1.41, migraine: 1.80) or selective serotonin reuptake inhibitors (1.73 and 1.72). Tricyclics were more likely to cause adverse effects than placebo (1.53) and selective serotonin reuptake inhibitors (2.22), including dry mouth, drowsiness, and weight gain, but did not increase dropout rates (placebo: 1.22, selective serotonin reuptake inhibitors: 1.16)."

The researchers concluded: "Tricyclic antidepressants are effective in preventing migraine and tension-type headaches and are more effective than selective serotonin reuptake inhibitors, although with greater adverse effects. The effectiveness of tricyclics seems to increase over time."

Good evidence for the role of antidepressants, especially tricyclics, in the prevention of migraines and tension-type headache.

For the full abstract, click here.

BMJ 341:c5222, 20 October 2010 © 2010 Jackson et al
Tricyclic antidepressants and headaches: systematic review and meta-analysis. Jeffrey L Jackson, William Shimeall, Laura Sessums, et al. Correspondence to J L Jackson: [email protected]

Category: N. Neurological. Keywords: tricyclic antidepressants, SSRIs, migraine headache, tension headache, prevention, systematic review and meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 2 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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