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Long-term tricyclic use beneficial for migraine

By Nigel Praities

A tricyclic antidepressant becomes a more effective treatment for migraine and tension headache the longer it is used, a new analysis concludes.

US researchers carried out a meta-analysis of 37 studies comparing tricyclics with other antidepressants and placebo.

Tricyclics have become a standard preventative treatment for headaches and in this analysis they significantly reduced the mean duration of tension headache by 1.3 days and the mean number of migraines by 0.7 days compared with placebo.

They were also more effective than other antidepressants - reducing the intensity of tension headaches by 73% and migraines by 72%, compared with SSRIs.

But the authors also concluded this ‘clinically large effect' increased over time. For every additional week of treatment, headache burden dropped by 0.16 standard deviations on validated scales.

Study leader Jeffrey Jackson, director of general medicine at the Reed Army Medical Center, Washington, USA, said: ‘The benefit [of tricyclics] seems moderate to large but it would be helpful to have studies showing which patients might be more likely to benefit from treatment - such as depressed patients or those with high use of analgesics.'

BMJ 2010, online 20 October

Tricyclics are effective for migraines and headaches