Venlafaxine reduces migraine attacks as well as amitriptyline, study shows
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In a noninferiority randomized trial, the antidepressants amitriptyline and venlafaxine significantly reduced the number of migraine attacks per month, according to researchers.
Although the treatment benefits were statistically similar, adverse events such as dry mouth, constipation, sleepiness, weight gain and fatigue were reported more frequently in patients with migraine who received amitriptyline. For this reason, “venlafaxine could have priority over amitriptyline in migraine prophylaxis,” Mohaddeseh Hedayat, PharmD, a faculty member in the department of pharmacology and toxicology at the Urmia University of Medical Sciences in Iran, and colleagues wrote in Clinical Neurology and Neurosurgery.
The researchers randomly assigned 80 patients (57.5% women; mean age, 33 years) who experienced at least three migraine attacks per month in a 1:1 ratio to receive either 25 mg of amitriptyline or 37.5 mg of venlafaxine daily for 8 weeks. The analysis excluded adults who were, or intended to become, pregnant; those who were breastfeeding; those allergic to or who previously received one of the study’s medications; those who received other migraine prophylactic treatments 1 month before study enrollment; and those who had cancer, hepatic dysfunction, renal dysfunction or CVD.
“The study did not intend to prohibit the concurrent administration of acute abortive treatment,” Hedayat and colleagues wrote.
The trial participants reported their symptoms and were subject to weekly monitoring until their last treatment dose.
According to the researchers, the amitriptyline cohort experienced a significant drop in the number of headaches per month, from 10.98 to 2.98, as did the venlafaxine cohort, from 9.98 to 3.18. The six-item Headache Impact Test (HIT-6) score, which measures pain, social functioning, role functioning, vitality, cognitive functioning and psychological distress, also significantly dropped in the amitriptyline cohort, from 67.78 points to 49.73 points, and in the venlafaxine cohort, from 66.65 points to 48.88 points.
“The results demonstrated no significant relationship between age or disease duration with the score of the HIT-6,” Hedayat and colleagues wrote. “The decrease rate in the score of the HIT-6 in males was higher than that of females, which shows the modifier role of the gender.”
References:
Hedayat M, et al. Clin Neurol Neurosurg. 2022;doi:10.1016/j.clineuro.2022.107151.
Shin EH, et al. J Clin Neurol. 2008;doi:10.3988/jcn.2008.4.4.158.
Perspective
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Today there are a number of new drugs for migraine like the calcitonin gene-related peptide inhibitors or Botox that you can suggest patients take for migraine. Clearly, as this study indicates, the antidepressants venlafaxine and amitriptyline also work for migraine. It is important for us as physicians to realize that if we do suggest these antidepressants to patients with migraine, the patient understands you are not dismissing their migraine pain.
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