Table 3

Pharmacological treatments used for migraine prevention and psychiatric comorbidities

TreatmentPsychiatric comorbidity useMigraine prevention effectiveness
Tricyclic antidepressants (TCAs), eg, amitriptylineEffective for depression at high doses, with more side effectsEffective for migraine prevention at low doses, with minimal side effects
Serotonin-Neuropinephrine Reuptake Inhibitors (SNRIs), eg, venlafaxineEffective for depression and decreases anxietyOnly venlafaxine has grade B evidence of efficacy for migraine prevention144
However, the most recent Cochrane study did not find venlafaxine to be more effective than placebo for prevention of chronic migraines145
Selective Serotonin Reuptake Inhibitors (SSRIs), eg, fluoxetineEffective for depressionAccording to the Cochrane review, SSRIs were not better than placebo for migraine prevention145
β-blockers, eg, propranololMight help with anxiety, but might also worsen depressionEffective for migraine prevention
 TopiramateMight help with mood stabilisation, but might also worsen depressionEffective for migraine prevention
 Divalproex sodiumMight help with mood stabilisation, bipolar disorderEffective for migraine prevention