Therapy of primary headaches: the role of antidepressants

Antidepressants are included in evidence-based guidelines for the prophylactic therapy of migraine. Although they can cause several side effects depending on the neurochemical activity, and are to be used with caution in older patients, some of them have a well-documented efficacy. Amitriptyline is classified as a Group 1 drug, whereas Fluoxetine is included in Group 2. There is fair support for the effectiveness of other serotonine reuptake inhibitors in migraine prevention. Amitriptyline has demonstrated a consistent efficacy in Chronic Tension Type Headache, and Mirtazapine has a promising profile for the treatment of the same disease.