Tricyclic antidepressants for migraine and tension-type headaches

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5250 (Published 20 October 2010) Cite this as: BMJ 2010;341:c5250
  1. Kenneth A Holroyd, distinguished professor1,
  2. Lars Bendtsen, associate professor2
  1. 1Department of Psychology, Ohio University, Athens, OH 45701, USA
  2. 2Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, DK-2600 Glostrup, Denmark
  1. holroyd{at}ohio.edu

Are largely beneficial, but a lack of research leaves important clinical questions unanswered

In the linked meta-analysis (doi:10.1136/bmj.c5222), Jackson and colleagues assess the efficacy of tricyclic antidepressants in the treatment of migraine, tension headache, and mixed headache.1

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Tricyclic antidepressants have a long history in the treatment of headache. In 1964 Lance and Curran reported a better response to amitriptyline (30-75 mg/day) in chronic tension headache (n=280) compared with 11 other commonly used drugs (such as benzodiazepines, vasodilators, and sedatives).2 They also reported a placebo controlled crossover trial of 27 patients that showed clinically significant improvements (≥50% reduction) in headaches in 55% of patients taking amitriptyline, but only 11% of those taking placebo. When the results for amitriptyline were aggregated across the two studies, the effect of amitriptyline became more pronounced over time, was independent of the presence of depression, was evident in patients with continuous as well as episodic headaches, and was most pronounced in older (≥60 year of age) patients. A decade passed before similar positive findings were …

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