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Reader's Mail: Can Preventive Treatment for Migraine Be Eliminated Over Time?

Q. My wife suffers from fairly regular migraine headaches and nausea. The doctor prescribed a course of antidepressants, which really help, but she doesn’t like relying on medication and doesn’t take them regularly. The doctor said she should take them every day for three months to truly benefit. If she does as he suggests, will it have a long-term benefit, i.e., will it get rid of the headaches even after she finishes the course of antidepressants? Or will she need to take the medication regularly as long as she suffers from migraines?

A. Migraine is an episodic neurological disorder that, if not treated properly, may progress into a chronic disease. Anyone with frequent migraine attacks—attacks that are debilitating, last too long, or impact the life of the sufferer in any way—should be on preventive medication.

Antidepressants, especially tricyclic antidepressants, are often used to reduce the frequency, duration and intensity of migraine attacks. Usually, you start with a low dose and slowly increase it over a period of several weeks. Patients should stay on a dose that provides significant improvement without major side effects for at least six months or preferably longer. Irregular use of medication will not provide the same relief as daily treatment. Indeed, antidepressants should not be used “as-needed” for migraine.

Once the patient achieves sustained improvement for at least 6-9 months, the medication can be slowly reduced to find the lowest dose that is still effective. Eventually, preventive drugs can be eliminated altogether. It is also very important to incorporate other non-drug treatments to manage migraines, such as avoiding triggers and using stress relief techniques.

George Urban, M.D.
Diamond Headache Clinic
Chicago, IL

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