[Antidepressants in migraine prophylaxis: an approximation]

Migraine is one of the most frequently observed neurological problems in primary health care centres, while major depressive disorder (MDD) is the most prevalent mental disorder in the general population. It has been observed that emotional factors can trigger or worsen bouts of migraine and there is a high rate of comorbidity between migraine and MDD in the general population. 50% of patients formally diagnosed as suffering from migraine also meet MDD criteria. The association found between these clinical entities is complex and not casual: it is not simply a matter of an emotional response to the recurring headaches.

Our aim was to report on the value of antidepressants in the prophylaxis of migraine.

The following have all been used in migraine prophylaxis: alpha2-agonists, calcium channel antagonists, anticonvulsive drugs, antidepressants, beta blockers, magnesium and serotoninergic agents, among others. It has been reported that antidepressant drugs with an important agonistic action on 5-HT2 receptors are useful in the prophylaxis of migraine. Furthermore, some antidepressants exert a direct analgesic effect and modulate the response to pain by means of neuronal mechanisms.

Antidepressants are undoubtedly the best alternative available for prophylaxis in patients who present migraine associated to MDD. Amitriptyline has proved itself to be effective in dosages ranging from 30 to 150 mg/day, while recent studies have also shown fluoxetin to be effective in doses of between 20 and 40 mg/day. Moreover, in general, antidepressants are drugs with a low risk of toxicity and few serious or very troublesome side effects.