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Antidepressants Ease Headaches

Study shows drugs lessen need for painkillers

THURSDAY, July 19, 2001 (HealthDayNews) -- Antidepressants of all kinds soothe migraines and tension headaches, a new roundup of studies shows.

Mood-lifting drugs are twice as effective on average as no treatment at improving headaches, and they significantly cut back on patient use of painkillers, the researchers say.

The study, reported in the July issue of the American Journal of Medicine, was led by Dr. Glen Tomkins, formerly of the Dwight David Eisenhower Army Medical Center in Georgia. He and his colleagues reviewed 38 previous trials of antidepressant use for headaches, including 25 that focused on migraines, 12 on tension headaches and one on both.

Most drugs tested were either earlier generations of antidepressants, which many neurologists already prescribe for headaches, or serotonin antagonists. Seven trials, however, looked at the newer class of selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft. The newer drugs boost levels of serotonin, a brain chemical that regulates mood, emotion and sleep.

Patients on any antidepressant were twice as likely as those on placebos to say their headaches improved, generally by a large degree, the researchers say. As a result, those folks turned to painkillers less often, consuming about 30 percent fewer analgesics on average than untreated patients.

The researchers couldn't say whether mood-lifting drugs help headaches independently, or whether that is simply a bonus of controlling depression.

While figuring that out is important, the "the bottom line is that patients get better," says study co-author Dr. Patrick O'Malley of the Walter Reed Army Medical Center.

O'Malley says the evidence clearly shows a benefit from earlier generations of antidepressants and serotonin antagonists, which are more common in Europe. However, he says the scarcity of studies on SSRIs leaves him "reluctant to rely on that data."

Dr. Fred Sheftell, president of the American Council for Headache Education, says clinical evidence seems to show SSRIs are not as effective as the older generation of drugs, such as amitriptyline and nortriptyline. That may reflect "cleaner" formulation of SSRIs, which target the serotonin messenger system without affecting other brain receptors that may be involved in headaches.

What To Do

It's estimated that one in three Americans will suffer a migraine or tension headache at some time. Treating migraines alone costs $1 billion a year, and the condition leads to some $13 billion in lost productivity.

To learn more about migraines and other chronic headaches, try the American Medical Association or the American Academy of Family Physicians.

You can also get more information through the American Council for Headache Education.

SOURCES: Interviews with Patrick O'Malley, M.D., M.P.H., chief, general internal medicine, Walter Reed Army Medical Center, Washington, D.C.; Fred Sheftell, M.D., president, American Council on Headache Education, director, New England Center for Headache, Stamford, Conn.; July 2001 American Journal of Medicine
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