, Volume 69, Issue 1, pp 1–19

Antidepressants in Long-Term Migraine Prevention

Current Opinion

DOI: 10.2165/00003495-200969010-00001

Cite this article as:
Koch, H.J. & Jürgens, T.P. Drugs (2009) 69: 1. doi:10.2165/00003495-200969010-00001


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.

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  1. 1.Department of Psychiatry and PsychotherapyKlinik für Psychiatrie und PsychotherapieAueGermany
  2. 2.Department of NeurologyBezirksklinikum RegensburgRegensburgGermany
  3. 3.Institute of Systems Neuroscience, Headache ClinicUniversity Medical Centre Hamburg-EppendorfHamburgGermany