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Reader's Mail: Choose Anti-Depressants Carefully for Migraine Prevention

Q. I have had migraines for approximately 20 years. I have bad months in which I have 6-10 days of headaches. The last month has been better since I started on Topamax for migraine prevention. However, I am feeling anxious and wondering if there is an anti-anxiety medication that is recommended. What are your thoughts about BuSpar and Paxil?

A. Paxil (paroxetine) is a serotonin-specific reuptake inhibitor (SSRI) that is indicated for both the treatment of depression and anxiety. BuSpar (buspirone) is specifically indicated for anxiety only. Either medication type is acceptable for the treatment of anxiety.

The SSRI class of anti-depressants can be very effective for treatment of anxiety and depression, but is not usually effective for the prevention of migraine. Some of the anti-depressant medications that are used for prevention of migraine include the tricyclic anti-depressant class, such as amitriptyline, nortriptyline and doxepin. Also, the newer serotonin-norepinephrine reuptake inhibitor class (SNRI), which includes venlafaxine (Effexor) and duloxetine (Cymbalta), has shown some benefit in the prevention of migraine.

George R. Nissan, DO
Baylor Comprehensive Headache Center
Dallas, Texas

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