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Older Antidepressants More Effective at Preventing Tension-type Headache and Migraine

The older class of tricyclic antidepressants are more effective at reducing the number and intensity of tension-type headaches and migraines than the newer selective serotonin reuptake inhibitor (SSRI) antidepressants, according to research published in the British Medical Journal. Tricyclic antidepressants have been used to prevent headaches since the 1960s.

The review of 37 studies found the tricyclics were equally effective in treating tension-type, migraine and mixed headaches. The study also found that patients who were treated with tricyclics for tension-type headaches used fewer analgesics and that the effectiveness of tricyclics increased over time. Tricyclics were more likely to cause adverse events than SSRIs, including dry mouth, drowsiness, and weight gain, but this did not result in significantly greater dropout rates.

“Patients treated prophylactically with tricyclics experienced about one standard deviation of improvement in headache burden, a clinically large effect,” the researchers wrote. “Moreover, the effect seems to increase overtime; patients in the first month of treatment had less improvement than those treated at six months.”

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