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Migraine, go away!

Posted on October 13, 2015

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Cochrane Review: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of migraine in adults.

Migraines are a burden to those who suffer from them; they can reduce one’s quality of life, decrease one’s ability to function, and even impair one’s performance. Preventative treatments can be used for people who have frequent and severe migraines despite the use of over the counter pain medication. These prophylactic treatments are intended to improve one’s quality of life and decrease the use of acute drugs. Though the mechanisms are not completely certain, some antidepressant drugs, such as amitriptyline, have been shown to effectively prevent migraines at lower doses than when used for depression. The goal of this Cochrane Review was to see if SSRIs and SNRIs were effective in the prevention of migraines.

Key message

SSRIs or SNRIs were not found to be any more effective than placebo or amitriptyline in reducing the reducing the frequency, intensity, and/or duration of migraines in adults.

Introduction

A migraine is a common neurological disorder characterized by recurrent, unilateral, pulsating headaches lasting several hours. Migraines are commonly associated with nausea and/or extreme sensitivity to light and fear of loud sounds. They can occur with or without aura—focal neurological symptoms that present before or during an episode. Migraines are a burden to those who suffer from them; they can reduce one’s quality of life, decrease one’s ability to function, and even impair one’s performance. Preventative treatments can be used for people who have frequent and severe migraines despite the use of over the counter pain medication. These prophylactic treatments are intended to improve one’s quality of life and decrease the use of acute drugs. Though the mechanisms are not completely certain, some antidepressant drugs, such as amitriptyline, have been shown to effectively prevent migraines at lower doses than when used for depression. SSRIs and SNRIs are typically used as antidepressants, but because the serotonergic system seems to be involved in migraine pathophysiology and because of successes such as amitriptyline, these drugs have been clinically tested for migraine prophylaxis.

What did they find?

Eleven studies were reviewed, and overall, SSRI’s and SNRI’s were not found to be more effective than placebo or amitriptyline. The newest study did repost a decrease in migraine frequency when an SSRI was compared to placebo, but the study was not completely reliable and a definite conclusion can’t be drawn from just a single study. Generally, people seemed to tolerate the SSRIs or SNRIs better than tricyclic antidepressants, but there was not statistically significant difference between the number of patients who withdrew due to adverse events.

How good was the evidence?

The quality and number of studies that were analyzed were weak. Limited valuable information was obtained from some studies because reporting was incomplete. Overall, the studies had short follow-ups, small sample sizes, frequent ambiguities, and inadequate blinding procedures—making the overall data poor. The outcomes tested in many of the studies seemed to have minimal clinical significance; most studies failed to report data about migraine frequency—the most relevant clinical outcome.

What does this change?

Based on this review, SSRIs and SNRIs don’t show any current benefit to patients suffering from migraines.

Looking ahead

Migraines are truly debilitating (speaking from experience) and are a common problem in our world today. There is still research to be done on possible treatment to prevent migraines, but also on the actual process of how in fact a migraine develops. The more we understand the pathophysiology of migraines, the more insight we will have on the kinds of drugs that can help prevent this disorder.

Links

Banzi R, Cusi C, Randazzo C, Sterzi R, Tedesco D, Moja L. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of migraine in adults. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD002919. DOI: 10.1002/14651858.CD002919.pub3

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002919.pub3/abstract

Alyssa G. Ricci

Alyssa G. Ricci

I am currently a third year dental student at Virginia Commonwealth University School of Dentistry. My goals are to become an Orthodontist as well as hopefully start a non-profit doing horse therapy with special needs kids. I'm a proud wife and horse owner, and I am fluent in Spanish. I believe research is an essential part of life. My focus is on dental-based research.

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Migraine, go away! by Alyssa G. Ricci is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Unless otherwise stated, all images used within the blog are not available for reuse or republication as they are purchased for Students 4 Best Evidence from shutterstock.com.

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