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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.

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Related in: MedlinePlus

Fig 5 Likelihood of adverse effects between tricyclic antidepressants and placebo
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fig5: Fig 5 Likelihood of adverse effects between tricyclic antidepressants and placebo

Mentions: Individual adverse effects of tricyclics compared with placebo were variably reported among the studies. In seven comparison arms, patients taking tricyclics were more likely to report “any” side effect than those taking placebo (relative risk 1.89, 95% confidence interval 1.18 to 3.02, I2=85.9%, fig 5). Among 10 individual adverse effects, only dry mouth (2.34, 1.63 to 3.35, I2=43.3%) and drowsiness (1.87, 1.25 to 2.70, I2=55.1%) were statistically more frequent in patients receiving tricyclics than in those receiving placebo (table 3). The likelihood of withdrawing due to adverse effects, however, did not differ among 16 placebo controlled trials (1.21, 0.80 to 1.82, I2=74.1%, fig 5).


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 5 Likelihood of adverse effects between tricyclic antidepressants and placebo
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: Fig 5 Likelihood of adverse effects between tricyclic antidepressants and placebo
Mentions: Individual adverse effects of tricyclics compared with placebo were variably reported among the studies. In seven comparison arms, patients taking tricyclics were more likely to report “any” side effect than those taking placebo (relative risk 1.89, 95% confidence interval 1.18 to 3.02, I2=85.9%, fig 5). Among 10 individual adverse effects, only dry mouth (2.34, 1.63 to 3.35, I2=43.3%) and drowsiness (1.87, 1.25 to 2.70, I2=55.1%) were statistically more frequent in patients receiving tricyclics than in those receiving placebo (table 3). The likelihood of withdrawing due to adverse effects, however, did not differ among 16 placebo controlled trials (1.21, 0.80 to 1.82, I2=74.1%, fig 5).

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