Which Type of Antidepressant Is Best for Migraine Prevention?

Health Professional

Full Question:

I've recently been diagnosed with depression, and the psychiatrist mentioned that many antidepressants are also used to prevent migraines. He didn't prescribe an antidepressant yet because I see my neurologist soon and he wanted to see if my neurologist wanted to prescribe it instead. I've been researching online and finding several different types of antidepressants. Is one type better than another for preventing migraines? Thanks for your help, Leighann.

Full Answer:

Dear Leighann;

We're sorry you have yet another diagnosis to deal with, but it's so much better to be diagnosed so you can take care of yourself than to go undiagnosed.

You're quite right that there are several categories of antidepressants. For many years, amitriptyline (a tricyclic) antidepressants was the one most often prescribed for migraine prevention. Some of the SSRI (selective serotonin re-uptake inhibitor) antidepressants such as Prozac and Paxil have also been used. In more recent years, greater use has been made of SNRI (serotonin and norepinephrine reuptake inhibitor). There are three antidepressants in this family - venlafaxine (brand name Effexor, which is now discontinued); duloxetine (Cymbalta); and desvenlafaxine (Pristiq).

The American Headache Society and American Academy issued joint recommendations for migraine prevention. Here's how antidepressants ranked there:

  • Listed under "probably effective and should be considered for migraine prevention:" amitriptyline and venlafaxine.
  • "Listed under "insufficient or conflicting evidence on the effectiveness of the following drugs for migraine prevention:" Fluoxetine (Prozac), protriptyline (Vivactil), fluvoxamine (Luvox)

You can read more about these guidelines in New Episodic Migraine Prevention Guidelines Released.

Thanks for your question,
Dave Watson and Teri Robert

About Ask the Clinician:

Dr. David Watson is a UCNS certified migraine and headache specialists and director of the Headache Center at West Virginia University. He and Lead Health Guide Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about _ Dr. Watson_ or more about _** Teri Robert** _.

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