Over 2 months of treatment , SSRIs are no more efficacious than placebo in patients with migraine .
In patients with chronic TTH , SSRIs are less efficacious than tricyclic antidepressants .
In comparison with SSRIs , the burden of adverse events in patients receiving tricyclics was greater .
BACKGROUND Headache is a common medical problem .
In view of recent discoveries about the role of serotonin in pain mechanisms , selective serotonin re-uptake inhibitors ( SSRIs ) have been evaluated for the prevention of  migraine and tension-type headaches ( TTH ) .
OBJECTIVES To evaluate the efficacy and tolerability of SSRIs for preventing migraine and TTH .
Fluoxetine prophylaxis of migraine.
Many patients with severe migraine remain refractory to the current treatment regimens or can not tolerate the side effects . Since current research implicates serotonin dysregulation in migraine pathogenesis , we investigated in a double blind , placebo controlled study the prophylactic effect of the serotonergic drug fluoxetine .  Sixteen subjects were r and omly assigned to 8 week fluoxetine treatment and 16 to the placebo group ; nine subjects in each group completed the study .  Migraine headache scores were obtained for two weeks prior to commencement of treatment , and then for each successive two week period . Zung depression scores were obtained before and after completion of the study . Fluoxetine caused significant reduction in headache scores starting with weeks 3 - 4 of treatment ; there was no significant change with placebo .  Depression scores did not differ between groups before treatment , and did not significantly change with either treatment . Fluoxetine appears to be a safe and effective drug for migraine prophylaxis , and deserves further therapeutic trials with larger groups for longer periods of time
Over 2 months of treatment , SSRIs are no more efficacious than placebo in patients with migraine .
In patients with chronic TTH , SSRIs are less efficacious than tricyclic antidepressants .
In comparison with SSRIs , the burden of adverse events in patients receiving tricyclics was greater .
BACKGROUND Headache is a common medical problem .
In view of recent discoveries about the role of serotonin in pain mechanisms , selective serotonin re-uptake inhibitors ( SSRIs ) have been evaluated for the prevention of  migraine and tension-type headaches ( TTH ) .
OBJECTIVES To evaluate the efficacy and tolerability of SSRIs for preventing migraine and TTH .