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Antidepressants in Long-Term Migraine Prevention

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Abstract

Migraine and depression coincide in some 20–30% of patients. Although antidepressants (namely tricyclics) are not considered as first-line prophylactic compounds in patients with migraine alone, several clinical trials support a remarkable benefit in the treatment of migraine and related headache disorders. However, treatment with one antidepressant alone often does not suffice to treat both disorders effectively. Therefore, combinations of classical antidepressants with both newer antidepressants and established prophylactic drugs (e.g. β-adrenergic receptor antagonists [β-blockers], topiramate and sodium valproate) are required. In addition, acute attack medication (such as triptans, ergotamines or analgesics) is regularly combined with the preventive medication, thus requiring elaborate knowledge about the complex network of potential interactions and contraindications. Fear of potentially serious interactions can frequently lead to insufficient treatment of both underlying disorders, with an enormous impact on the patient’s life. Pathophysiologically, multiple neurotransmitters have been attributed an important role in the aetiology of migraine (mainly serotonin and calcitonin gene-related peptide) and depression (among others, serotonin, dopamine and noradrenaline [norepinephrine]). Most drugs used to treat both disorders influence at least one of these transmitter systems, such as classical tricyclics. This review discusses the efficacy of antidepressants in migraine prevention. In addition, recommended combinations in patients with concomitant depression and migraine are presented with regard to their proposed pharmacological mechanism of action and their potential interactions.

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Acknowledgements

No sources of funding were used in the preparation of this article. Dr Jürgens has received honoraria from GlaxoSmithKline and grants from Merck Sharpe & Dohme. Dr Koch has no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Klinik für Psychiatrie und Psychotherapie, Helios Klinikum Aue, Gartenstr. 6, D-08280, Aue, Germany

    Horst J. Koch

  2. Department of Neurology, Bezirksklinikum Regensburg, Regensburg, Germany

    Tim P. Jürgens

  3. Institute of Systems Neuroscience, Headache Clinic, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

    Tim P. Jürgens

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  1. Horst J. Koch
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Correspondence to Horst J. Koch.

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Koch, H.J., Jürgens, T.P. Antidepressants in Long-Term Migraine Prevention. Drugs 69, 1–19 (2009). https://doi.org/10.2165/00003495-200969010-00001

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