Limits...
Tricyclic antidepressants and headaches: systematic review and meta-analysis.

Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, Berbano E, O'Malley PG - BMJ (2010)

Bottom Line: Tricyclics were more likely to cause adverse effects than placebo (1.53, 95% confidence interval 1.11 to 2.12) and selective serotonin reuptake inhibitors (2.22, 1.52 to 3.32), including dry mouth (P<0.0005 for both), drowsiness (P<0.0005 for both), and weight gain (P<0.001 for both), but did not increase dropout rates (placebo: 1.22, 0.83 to 1.80, selective serotonin reuptake inhibitors: 1.16, 0.81 to 2.97).Tricyclic antidepressants are effective in preventing migraine and tension-type headaches and are more effective than selective serotonin reuptake inhibitors, although with greater adverse effects.The effectiveness of tricyclics seems to increase over time.

View Article: PubMed Central - PubMed

Affiliation: General Medicine Division, Walter Reed Army Medical Center, Washington, DC, USA. Jeffrey.jackson6@va.gov

ABSTRACT

Objective: To evaluate the efficacy and relative adverse effects of tricyclic antidepressants in the treatment of migraine, tension-type, and mixed headaches.

Design: Meta-analysis.

Data sources: Medline, Embase, the Cochrane Trials Registry, and PsycLIT. Studies reviewed Randomised trials of adults receiving tricyclics as only treatment for a minimum of four weeks.

Data extraction: Frequency of headaches (number of headache attacks for migraine and number of days with headache for tension-type headaches), intensity of headache, and headache index.

Results: 37 studies met the inclusion criteria. Tricyclics significantly reduced the number of days with tension-type headache and number of headache attacks from migraine than placebo (average standardised mean difference -1.29, 95% confidence interval -2.18 to -0.39 and -0.70, -0.93 to -0.48) but not compared with selective serotonin reuptake inhibitors (-0.80, -2.63 to 0.02 and -0.20, -0.60 to 0.19). The effect of tricyclics increased with longer duration of treatment (β=-0.11, 95% confidence interval -0.63 to -0.15; P<0.0005). Tricyclics were also more likely to reduce the intensity of headaches by at least 50% than either placebo (tension-type: relative risk 1.41, 95% confidence interval 1.02 to 1.89; migraine: 1.80, 1.24 to 2.62) or selective serotonin reuptake inhibitors (1.73, 1.34 to 2.22 and 1.72, 1.15 to 2.55). Tricyclics were more likely to cause adverse effects than placebo (1.53, 95% confidence interval 1.11 to 2.12) and selective serotonin reuptake inhibitors (2.22, 1.52 to 3.32), including dry mouth (P<0.0005 for both), drowsiness (P<0.0005 for both), and weight gain (P<0.001 for both), but did not increase dropout rates (placebo: 1.22, 0.83 to 1.80, selective serotonin reuptake inhibitors: 1.16, 0.81 to 2.97).

Conclusions: Tricyclic antidepressants are effective in preventing migraine and tension-type headaches and are more effective than selective serotonin reuptake inhibitors, although with greater adverse effects. The effectiveness of tricyclics seems to increase over time.

Show MeSH

Related in: MedlinePlus

Fig 3 Effect of tricyclic antidepressants compared with placebo over time. SMD=standardised mean difference
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC2958257&req=5

fig3: Fig 3 Effect of tricyclic antidepressants compared with placebo over time. SMD=standardised mean difference

Mentions: The number of headaches per month among studies reporting it were reduced on average by 6.9 for tension-type headaches (95% confidence interval −21.6 to 7.7, three studies) and 1.4 for migraine headaches (−3.3 to 0.5, four studies). For both headache types this beneficial effect increased over time (tension-type: β=−0.16, 95% confidence interval −0.23 to −0.10, P<0.0005, migraine: β=−0.09, −0.14 to −0.04, P=0.001, fig 3). Therefore for every additional week of treatment with a tricyclic, the number of headaches were reduced by 0.16 standard deviations. Among these trials, a range of tricyclic doses was used, with an average dose that was 50% of the maximum for the particular tricyclic studied. The effect of doses less than 50% of the maximum dose was lower than those with higher doses (average standardised mean difference −0.73, 95% confidence interval −1.14 to −0.32 v −0.92, −1.50 to −0.34), although the difference was not significant (P=0.34).


Tricyclic antidepressants and headaches: systematic review and meta-analysis.

Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, Berbano E, O'Malley PG - BMJ (2010)

Fig 3 Effect of tricyclic antidepressants compared with placebo over time. SMD=standardised mean difference
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2958257&req=5

fig3: Fig 3 Effect of tricyclic antidepressants compared with placebo over time. SMD=standardised mean difference
Mentions: The number of headaches per month among studies reporting it were reduced on average by 6.9 for tension-type headaches (95% confidence interval −21.6 to 7.7, three studies) and 1.4 for migraine headaches (−3.3 to 0.5, four studies). For both headache types this beneficial effect increased over time (tension-type: β=−0.16, 95% confidence interval −0.23 to −0.10, P<0.0005, migraine: β=−0.09, −0.14 to −0.04, P=0.001, fig 3). Therefore for every additional week of treatment with a tricyclic, the number of headaches were reduced by 0.16 standard deviations. Among these trials, a range of tricyclic doses was used, with an average dose that was 50% of the maximum for the particular tricyclic studied. The effect of doses less than 50% of the maximum dose was lower than those with higher doses (average standardised mean difference −0.73, 95% confidence interval −1.14 to −0.32 v −0.92, −1.50 to −0.34), although the difference was not significant (P=0.34).

Bottom Line: Tricyclics were more likely to cause adverse effects than placebo (1.53, 95% confidence interval 1.11 to 2.12) and selective serotonin reuptake inhibitors (2.22, 1.52 to 3.32), including dry mouth (P<0.0005 for both), drowsiness (P<0.0005 for both), and weight gain (P<0.001 for both), but did not increase dropout rates (placebo: 1.22, 0.83 to 1.80, selective serotonin reuptake inhibitors: 1.16, 0.81 to 2.97).Tricyclic antidepressants are effective in preventing migraine and tension-type headaches and are more effective than selective serotonin reuptake inhibitors, although with greater adverse effects.The effectiveness of tricyclics seems to increase over time.

View Article: PubMed Central - PubMed

Affiliation: General Medicine Division, Walter Reed Army Medical Center, Washington, DC, USA. Jeffrey.jackson6@va.gov

ABSTRACT

Objective: To evaluate the efficacy and relative adverse effects of tricyclic antidepressants in the treatment of migraine, tension-type, and mixed headaches.

Design: Meta-analysis.

Data sources: Medline, Embase, the Cochrane Trials Registry, and PsycLIT. Studies reviewed Randomised trials of adults receiving tricyclics as only treatment for a minimum of four weeks.

Data extraction: Frequency of headaches (number of headache attacks for migraine and number of days with headache for tension-type headaches), intensity of headache, and headache index.

Results: 37 studies met the inclusion criteria. Tricyclics significantly reduced the number of days with tension-type headache and number of headache attacks from migraine than placebo (average standardised mean difference -1.29, 95% confidence interval -2.18 to -0.39 and -0.70, -0.93 to -0.48) but not compared with selective serotonin reuptake inhibitors (-0.80, -2.63 to 0.02 and -0.20, -0.60 to 0.19). The effect of tricyclics increased with longer duration of treatment (β=-0.11, 95% confidence interval -0.63 to -0.15; P<0.0005). Tricyclics were also more likely to reduce the intensity of headaches by at least 50% than either placebo (tension-type: relative risk 1.41, 95% confidence interval 1.02 to 1.89; migraine: 1.80, 1.24 to 2.62) or selective serotonin reuptake inhibitors (1.73, 1.34 to 2.22 and 1.72, 1.15 to 2.55). Tricyclics were more likely to cause adverse effects than placebo (1.53, 95% confidence interval 1.11 to 2.12) and selective serotonin reuptake inhibitors (2.22, 1.52 to 3.32), including dry mouth (P<0.0005 for both), drowsiness (P<0.0005 for both), and weight gain (P<0.001 for both), but did not increase dropout rates (placebo: 1.22, 0.83 to 1.80, selective serotonin reuptake inhibitors: 1.16, 0.81 to 2.97).

Conclusions: Tricyclic antidepressants are effective in preventing migraine and tension-type headaches and are more effective than selective serotonin reuptake inhibitors, although with greater adverse effects. The effectiveness of tricyclics seems to increase over time.

Show MeSH
Related in: MedlinePlus