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Prevention 101

Question:

What antidepressants are used to help prevent migraine?

Expert:   Joshua Cohen, M.D., M.P.H. , St. Luke’s-Roosevelt Hospital Center »

Even though their primary purpose is to treat depression, doctors may prescribe some antidepressants as a preventive form of migraine medication. Watch this to learn what they are!

Transcript: Even though their primary purpose is to treat depression, doctors may prescribe some ANTIDEPRESSANTS as a preventive form of migraine medication. Migraines develop, in part, by inappropriate activity of the chemical messenger, serotonin, in the brain. Antidepressants may PREVENT the headaches by REGULATING the serotonin. Doctors have found that the antidepressants MOST effective against migraine are those that are called TRICYCLIC antidepressants. The medications in this category include amitrptyline, PROtriptyline, NORtriptyline, imipramine, desipramine and doxepin. They MAY take several weeks to start working. Doctors OCASSIONALLY prescribe OTHER types of antidepressants, such as SSRIs, SNRIs and MAOIs, to reduce migraine headache attacks. Your doctor will be the best judge of which, if any, of these options might be helpful to you. Although current research is promising, antidepressants are NOT approved by the Food and Drug Administration for migraine prevention. Your doctor’s prescriptions are perfectly legal, they’re just off-label and the drugs have no been fully studied for use on migraine. No matter which antidepressant your neurologist prescribes, it will probably be at a LOWER dose than what’s needed to treat depression. Combining antidepressants with migraine TREATMENT medications is sometimes dangerous. TRIPTANS are a type of drug that STOPS a migraine in its tracks by regulating the level of serotonin in the brain, just like antidepressants. Putting the two together may cause a person to develop serotonin syndrome, a life-threatening condition that arises when there’s TOO much serotonin in the body. That’s why it’s VERY important to discuss your migraine medication plan with your doctor. More »

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