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For decades, clinicians have prescribed tricyclic antidepressant drugs for patients with migraine and tension headaches. In this meta-analysis of 37 randomized trials (average duration, 10 weeks) involving nearly 3200 patients (73% women; mean age, 40), investigators compared the efficacy of tricyclics with that of placebo, selective serotonin reuptake inhibitors (SSRIs), and β-blockers in the treatment of migraine and tension headaches. Amitriptyline and clomipramine were the most common tricyclics in the trials.
Tricyclics were compared with placebo in 20 trials. Tricyclics were significantly more effective than placebo in reducing the burden of both headache types: Tricyclics reduced the mean number of headaches monthly by 1.4 for migrain…