Antidepressants for migraine headaches

Antidepressant medications, which are usually used to treat depression, can be effective in preventing migraine headaches. Antidepressants have some pain-relieving properties and may reduce duration and frequency of headaches. Antidepressants are also used to improve sleep problems.

Antidepressants that are used to prevent migraines include:

• Tricyclic antidepressants.
• Monoamine oxidase inhibitors (MAOIs).

Amitriptyline, a tricyclic antidepressant, has been shown to be effective in preventing migraines.¹ Other tricyclic antidepressants may be tried if you do not respond well to amitriptyline, although the evidence to support their effectiveness varies.

The choice of antidepressant to treat your migraines may depend on your ability to tolerate the side effects of the medication.

Side effects of tricyclic antidepressants include:

• Dry mouth.
• Constipation.
• Blurred vision.
• Inability to urinate.
• Weight gain.
• Low blood pressure when you stand up quickly.
• Sleepiness.

Side effects of MAOIs include:

• Difficulty getting to sleep.
• Dizziness, lightheadedness, and fainting.
• Dry mouth.
• Blurred vision.
• Appetite changes.
• High blood pressure.
• Changes in heart rate and rhythm.
• Muscle twitching and feelings of restlessness.
• Loss of sexual desire or ability.
• Weight gain.
• Negative interactions with other medications and some foods.

You must also avoid certain foods that contain tyramine when you are taking an MAOI to avoid harmful interactions. Examples of foods to avoid include:

• Chocolate.
• Alcohol.
• Aged, canned, cured, or processed meat.
• Aged cheeses, such as blue, cheddar, and mozzarella.
• Food that contains monosodium glutamate (MSG).

FDA Advisories

The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

The FDA has also issued a warning about taking SSRIs or SNRIs (two kinds of antidepressant medicines) with triptans (used for migraines). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

Citations

1. Snow V, et al. (2002). Pharmacologic management of acute attacks of migraine and prevention of migraine headaches. Annals of Internal Medicine, 137(10): 840–849.