Amitriptyline in Migraine Prophylaxis

Couch, J. R.; Hassanein, Ruth S.

doi:10.1001/archneur.1979.00500470065013

Cited by 297 publications

(160 citation statements)

References 28 publications

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“…Amitriptyline was better than placebo in reducing monthly migraine, but only in patients with depression or baseline frequent and severe migraine 93 (OR, 2.4; 95 % CI, 1.45-3.8 for every additional day of migraine at baseline). 94 No trials directly compared drug effects in patients with and without aura.…”

Section: Drug Effect Modification By Select Patient Characteristicsmentioning

confidence: 92%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

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ELIGIBILITY CRITERIA: English-language randomized controlled trials (RCTs) of preventive drugs compared to placebo or active treatments examining rates of ≥50 % reduction in monthly migraine frequency or improvement in quality of life. STUDY APPRAISAL AND SYNTHESIS METHODS:We assessed risk of bias and strength of evidence and conducted random effects meta-analyses of absolute risk differences and Bayesian network meta-analysis. RESULTS: Of 5,244 retrieved references, 215 publications of RCTs provided mostly low-strength evidence because of the risk of bias and imprecision. RCTs examined 59 drugs from 14 drug classes. All approved drugs, including topiramate (9 RCTs), divalproex (3 RCTs), timolol (3 RCTs), and propranolol (4 RCTs); offlabel beta blockers metoprolol (4 RCTs), atenolol (1 RCT), nadolol (1 RCT), and acebutolol (1 RCT); angiotensin-converting enzyme inhibitors captopril (1 RCT) and lisinopril (1 RCT); and angiotensin II receptor blocker candesartan (1 RCT), outperformed placebo in reducing monthly migraine frequency by ≥50 % in 200-400 patients per 1,000 treated. Adverse effects leading to treatment discontinuation (68 RCTs) were greater with topiramate, off-label antiepileptics, and antidepressants than with placebo. Limited direct evidence as well as frequentist and exploratory network Bayesian meta-analysis showed no statistically significant differences in benefits between approved drugs. Off-label angiotensin-inhibiting drugs and beta-blockers were most effective and tolerable for episodic migraine prevention. LIMITATIONS:We did not quantify reporting bias or contact principal investigators regarding unpublished trials. CONCLUSIONS: Approved drugs prevented episodic migraine frequency by ≥50 % with no statistically significant difference between them. Exploratory network meta-analysis suggested that off-label angiotensin-inhibiting drugs and beta-blockers had favorable benefit-to-harm ratios. Evidence is lacking for longterm effects of drug treatments (i.e., trials of more than 3 months duration), especially for quality of life.KEY WORDS: migraine; evidence based medicine; adverse drug effects.

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Section: Drug Effect Modification By Select Patient Characteristicsmentioning

confidence: 92%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

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“…Many antidepressants in current use such as imipramine, amitriptyline and fluoxetine block the neuronal uptake of (Chouinard, 1985). It has also been demonstrated that administration of amitriptyline was associated with analgesic effects in patients with migraine or postherpetic neuralgia (Taub, 1973;Couch et al, 1976;Watson et al, 1982). Cl- (D Macmillan Press Ltd, 1992 5-HTlB AGONIST PROPERTIES OF ANPIRTOLINE 733…”

Section: Introductionmentioning

confidence: 99%

Anpirtoline, a novel, highly potent 5‐HT_1B receptor agonist with antinociceptive/antidepressant‐like actions in rodents

Schlicker

Ulrich²,

Hamon

et al. 1992

British J Pharmacology

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3 Like 5-HT, anpirtoline concentration-dependently inhibited forskolin-stimulated adenylate cyclase activity in homogenates from the rat substantia nigra. Both effects were not additive, and could be prevented by 5-HTlB receptor antagonists such as propranolol and penbutolol.4 In superfused rat and pig brain cortex slices preincubated with [3H]-5-HT, the electrically evoked tritium overflow was inhibited by anpirtoline and 5-HT. Whereas 5-HT was equipotent in both tissues (EC50 = 69 nM), anpirtoline was markedly less potent in pig brain cortex slices (EC50 = 1190 nM) than in rat brain cortex slices (EC50 = 55 nM). The concentration-response curve for anpirtoline was shifted to the right by metitepine in both preparations. 5 In the social behaviour deficit test, anpirtoline and trifluoromethylphenyl-piperazine were effective in reversing the isolation-induced impairments in mice, an effect shown only by compounds with agonist properties at the 5-HTIB receptor.6 In the electrostimulated pain test using mice, anpirtoline dose-dependently increased the pain threshold with an ED50 of 0.52mgkg-1, i.p. The antinociceptive activity of anpirtoline was abolished by pretreatment with cyproheptadine or propranolol. 7 In the forced swimming test in rats, anpirtoline induced a dose-related increase in swimming activity. With an ED50 value of 4.6mgkg-1, i.p., anpirtoline was 4 times more potent than the two standard compounds imipramine and desipramine. The decrease of immobility time or the increase of active periods in this model of behavioural despair is suggested to be characteristic of ant-depressant drugs. 8 Anpirtoline exhibits both antinociceptive and antidepressant-like activities in animals. It is probable that anpirtoline elicits these pharmacological effects via its agonist effect on 5-HT1B and 5-HT1A receptors.

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“…Amitriptyline was found to be superior to placebo in reducing attack frequency [5][6][7]15] and severity [6]. Flunarizine has been compared to placebo and found superior in its effects on attack frequency [9][10][11]13] but not on attack severity [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Many drugs of different categories have been used in migraine prophylaxis so far. As they have to be used for a long time, their efficiency is frequently shadowed by their side effects, sometimes resulting in discontinuance of the drug [2][3][4][5][6][7]. The most commonly used drugs for migraine prophylaxis are beta-blockers, tricyclic antidepressants, especially amitriptyline, and calcium channel blockers, especially flunarizine [5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

A comparative study of magnesium, flunarizine and amitriptyline in the prophylaxis of migraine

et al. 2000

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Circumstantial evidence points to the possible role of magnesium (Mg +2 ) deficiency in the pathogenesis of migraine and has raised questions about the clinical utility of magnesium as a therapeutic regimen in migraine. This was a prospective, randomized, double-blind, placebocontrolled trial comparing the efficacy and tolerability of 1830 mg magnesium citrate (23 patients), 10 mg flunarizine (22 patients) and 10 mg amitriptyline (20 patients) with placebo (22 patients) in the prophylaxis of migraine diagnosed according to the criteria of the International Headache Society. Patients were evaluated for attack frequency, severity and drug side effects monthly for 3 months. Magnesium, flunarizine and amitriptyline were all superior to placebo (p<0.001) in reducing both attack frequency and severity after the first month. There was no significant difference between the 3 active drugs in reduction of attack frequency and severity. No serious side effects were observed and the frequencies of side effects were not significantly different in all treatment groups. Our results show that oral magnesium is an effective and well tolerated drug in the prophylaxis of migraine and compares well to established drugs like flunarizine and amitriptyline both in effectiveness and occurence of side effects. Magnesium may be an alternative drug in migraine prophylaxis, but more and larger comparative trials are needed to confirm these results.

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Amitriptyline in Migraine Prophylaxis

Cited by 297 publications

References 28 publications

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Anpirtoline, a novel, highly potent 5‐HT_1B receptor agonist with antinociceptive/antidepressant‐like actions in rodents

A comparative study of magnesium, flunarizine and amitriptyline in the prophylaxis of migraine

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Amitriptyline in Migraine Prophylaxis

Cited by 297 publications

References 28 publications

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Anpirtoline, a novel, highly potent 5‐HT1B receptor agonist with antinociceptive/antidepressant‐like actions in rodents

A comparative study of magnesium, flunarizine and amitriptyline in the prophylaxis of migraine

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Anpirtoline, a novel, highly potent 5‐HT_1B receptor agonist with antinociceptive/antidepressant‐like actions in rodents