Two studies compared SSRIs or SNRIs versus amitriptyline and found no evidence for a difference in terms of migraine frequency ( st and ardised mean difference ( SMD ) 0.04 , 95 % confidence interval ( CI ) -0.72 to 0.80 ; I(2 ) = 72 % ) , or other secondary outcomes such as migraine intensity and duration .SSRIs  or SNRIs were generally more tolerable than tricyclics .
Since the last version of this review , the new included studies have not added high quality evidence to support the use of SSRIs or venlafaxine as preventive drugs for migraine .
There is no evidence to consider SSRIs or venlafaxine as more effective than placebo or amitriptyline in reducing migraine frequency , intensity , and duration over two to three months of treatment .
Our conclusion is that the use of SSRIs and SNRIs for migraine prophylaxis is not supported by evidence
BACKGROUND This is an up date d version of the original Cochrane review published in 2005 on selective serotonin reuptake inhibitors ( SSRIs ) for preventing  migraine and tension-type headache .
Another up date d review is under development to cover tension-type headache .
Migraine is a common disorder .
The chronic forms are associated with disability and have a high economic impact .
In view of discoveries about the role of serotonin and other neurotransmitters in pain mechanisms , selective serotonin reuptake inhibitors ( SSRIs ) and serotonin-norepinephrine reuptake inhibitors ( SNRIs ) have been evaluated for the prevention of migraine .
OBJECTIVES To determine the efficacy and tolerability of SSRIs and SNRIs compared to placebo and other active interventions in the prevention of episodic and chronic migraine in adults .
Escitalopram and Venlafaxine for the Prophylaxis of Migraine Headache Without Mood Disorders
There is evidence that some antidepressant drugs are beneficial in the prophylaxis of  migraine .  Previous reports have shown that migraine patients may respond to various antidepressant agents used for prophylactic therapy . The main purpose of this study was to compare the efficacy of antidepressants from 2 different groups ( venlafaxine vs escitalopram ) on people who had migraine headache without depression or anxiety . In this prospect i ve study , we evaluated the headache diaries of 93 patients who were being treated with venlafaxine ( n = 35 ) and escitalopram ( n = 58 ) . At the end of the 3-month period , patients were reassessed , and those with marked differences in attack frequency , duration , intensity ( with visual analog scales ) , lost work-day equivalent index , and migraine disability assessment question naire were compared . There was a clear reduction in headache frequency ( P < 0.0001 ) , duration ( P < 0.0001 ) , and severity ( P < 0.0001 ) in the venlafaxine group . In addition , there was a significant improvement in daily work performance during headaches ( P < 0.0001 ) . In the escitalopram group , monthly headache frequency ( P < 0.026 ) , duration ( P < 0.002 ) , and intensity ( P < 0.027 ) all decreased significantly , although not to the same extent as with venlafaxine . After the third month of venlafaxine and escitalopram treatment , most of the patients ( 82.8 % vs 96.5 % ) were seen to have moved to the minimal or infrequent migraine disability assessment group . According to our findings , venlafaxine and escitalopram are both effective in the prophylaxis of migraine headache without depression and anxiety . This effect was independent of mood disorder . Escitalopram should be the first choice because of its fewer side effects , but venlafaxine may be used if escitalopram is found to be insufficient
Two studies compared SSRIs or SNRIs versus amitriptyline and found no evidence for a difference in terms of migraine frequency ( st and ardised mean difference ( SMD ) 0.04 , 95 % confidence interval ( CI ) -0.72 to 0.80 ; I(2 ) = 72 % ) , or other secondary outcomes such as migraine intensity and duration .SSRIs  or SNRIs were generally more tolerable than tricyclics .
Since the last version of this review , the new included studies have not added high quality evidence to support the use of SSRIs or venlafaxine as preventive drugs for migraine .
There is no evidence to consider SSRIs or venlafaxine as more effective than placebo or amitriptyline in reducing migraine frequency , intensity , and duration over two to three months of treatment .
Our conclusion is that the use of SSRIs and SNRIs for migraine prophylaxis is not supported by evidence
BACKGROUND This is an up date d version of the original Cochrane review published in 2005 on selective serotonin reuptake inhibitors ( SSRIs ) for preventing  migraine and tension-type headache .
Another up date d review is under development to cover tension-type headache .
Migraine is a common disorder .
The chronic forms are associated with disability and have a high economic impact .
In view of discoveries about the role of serotonin and other neurotransmitters in pain mechanisms , selective serotonin reuptake inhibitors ( SSRIs ) and serotonin-norepinephrine reuptake inhibitors ( SNRIs ) have been evaluated for the prevention of migraine .
OBJECTIVES To determine the efficacy and tolerability of SSRIs and SNRIs compared to placebo and other active interventions in the prevention of episodic and chronic migraine in adults .