The Role of SNRIs in Migraine Prophylaxis

The role of serotonin-norepinephrine reuptake inhibitors (SNRIs) in migraine prophylaxis has not been completely established. Current treatments for vestibular migraine (VM) are based on scarce evidence.

Researchers conducted the first meta-analysis to examine the efficacy of Serotonin-norepinephrine reuptake inhibitors (SNRIs) for the treatment and prevention of vestibular migraine.

They found that serotonin-norepinephrine reuptake inhibitors (SNRIs) are effective and safe for the prevention of vestibular migraine (VM) and maybe the best option for patients with comorbid psychiatric disorders. The study also found that SNRIs are effective as prophylaxis for migraines, confirming earlier research findings.

Study Details

The researchers conducted a meta-analysis of 6 randomized controlled trials involving 418 patients. They searched PubMed, Web of Science, and Cochrane Library databases for relevant studies. The primary outcome was the migraine frequency. In the case of VM, the Dizziness Handicap Inventory (DHI) scores and Vertigo Severity Scores (VSSs) were extracted.

It was found that patients receiving SNRIs had fewer migraine days than those receiving a placebo (standardized mean difference -0.38, 95% CI -0.76 to -0.01, p=0.04). The effects of SNRIs and other active drugs were comparable. In patients with VM, venlafaxine had a significant advantage over other active drugs in decreasing the VSS (weighted mean difference (MD) -1.45, 95% CI -2.11 to -0.78, p<0.0001) and the emotional domain score of the DHI (MD -2.64, 95% CI -4.97 to -0.31, p=0.03). They found no significant difference in the rate of withdrawals due to any reason or withdrawals due to side effects between SNRIs and active drugs and between SNRIs and a placebo.

Conclusion

The investigators concluded that SNRIs were clinically safe and effective for migraine and vestibular migraine prophylaxis, were better than a placebo, and not inferior to other active drugs. SNRIs may be a preferable choice for patients with VM with psychiatric disorders.

Reference

For further reference log on to:

• Wang F, Wang J, Cao Y, Xu Z. Serotonin-norepinephrine reuptake inhibitors for the prevention of migraine and vestibular migraine: a systematic review and meta-analysis. Reg Anesth Pain Med. 2020 Mar 23 [Epub ahead of print]. doi: 10.1136/rapm-2019-101207. PMID: 32205412