Long-term tricyclics help migraine
Tricyclic antidepressants become more effective at preventing migraine and tension-type headaches the longer they are used, a systematic review shows.
The study of 37 randomised trials showed that tricyclics led to an average of 6.9 fewer tension-type headaches and 1.4 fewer migraines per month than placebo. But for both headache types, the effect increased over time, so that for each additional week of treatment the number of headaches fell by 0.16 standard deviations.
As reported in the British Medical Journal, patients with tension-type headaches or migraine who took tricyclics were also 40-80% more likely to have at least a 50% improvement in their headaches than those taking placebo. Those taking tricyclics for tension-type headache took fewer analgesics.
Tricyclics also increased the chance of at least a 50% improvement in either headache type compared with selective serotonin reuptake inhibitors (SSRIs), by around 70%.
However, the authors caution that relatively few studies have compared tricyclics with SSRIs, or indeed other drugs. And tricyclics were more likely to cause adverse effects than placebo and SSRIs, such as dry mouth and drowsiness, although they did not increase dropout rates.
Jeffrey Jackson (Walter Reed Army Medical Center, Washington, DC, USA) and co-investigators say further studies are needed "to determine whether particular subgroups of patients are more likely to respond to treatment with tricyclics, such as depressed patients or those with high use of analgesics", as well as to determine optimal treatment regimens and compare tricyclics with other preventative treatments.
GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Caroline Price