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 .
Canadian Headache Society guideline for migraine prophylaxis.
OBJECTIVES The primary objective of this guideline is to assist the practitioner in choosing an appropriate prophylactic medication for an individual with migraine , based on current evidence in the medical literature and expert consensus . This guideline is focused on patients with episodic migraine ( headache on ≤ 14 days a month ) . METHODS Through a comprehensive search strategy , r and omized , double blind , controlled trials of drug treatments for migraine prophylaxis and relevant Cochrane review s were identified . Studies were grade d according to criteria developed by the US Preventive Services Task Force . Recommendations were grade d according to the principles of the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) Working Group . In addition , a general literature review and expert consensus were used for aspects of prophylactic therapy for which r and omized controlled trials are not available . RESULTS Prophylactic drug choice should be based on evidence for efficacy , side-effect profile , migraine clinical features , and co-existing disorders . Based on our review , 11 prophylactic drugs received a strong recommendation for use ( topiramate , propranolol , nadolol , metoprolol , amitriptyline , gabapentin , c and esartan , butterbur , riboflavin , coenzyme Q10 , and magnesium citrate ) and 6 received a weak recommendation ( divalproex sodium , flunarizine , pizotifen , venlafaxine , verapamil , and lisinopril ) . Quality of evidence for different medications varied from high to low . Prophylactic treatment strategies were developed to assist the practitioner in selecting a prophylactic drug for specific clinical situations . These strategies included : first time strategies for patients who have not had prophylaxis before ( a beta-blocker and a tricyclic strategy ) , low side effect strategies ( including both drug and herbal/vitamin/mineral strategies ) , a strategy for patients with high body mass index , strategies for patients with co-existent hypertension or with co-existent depression and /or anxiety , and additional monotherapy drug strategies for patients who have failed previous prophylactic trials . Further strategies included a refractory migraine strategy and strategies for prophylaxis during pregnancy and lactation . CONCLUSIONS There is good evidence from r and omized controlled trials for use of a number of different prophylactic medications in patients with migraine . Medication choice for an individual patient requires careful consideration of patient clinical features
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 .