A comparative efficiency of amitriptyline, fluoxetine and maprotiline in preventive treatment of migraine in attack-free period

To reduce frequency and severity of the attacks, migraine was treated preve ntively between the attacks. The most effective drugs were beta-blockers an d antidepressants. In a single-blind study we estimated comparative efficie ncy of amitriptiline (inhibitor of noradrenaline and serotonin reuptake and 5-HT2-receptor antagonist) 12,5-25 mg/daily, fluoxetine (a selective serot onin reuptake inhibitor) 10-20 mg/daily, and maprotiline (a selective norad renaline reuptake inhibitor) 10-25 mg/daily. The duration of the therapy of migraine between the attacks was 12 weeks. Each group included 20 patients . 46 patients completed the whole course of therapy: 14 patients received a mitriptyline, 16 patients - fluoxetine, and 16 patients - maprotiline. Posi tive results of the (treatment (a reduction of the frequency of the migrain e attacks during a treatment by 50% as compared with the baseline period) w ere observed in 71% of the patients treated with amitriptyline, in 56% of t he patients treated with fluoxetine, and in 38% of the patients treated wit h maprotiline. All the drugs were able to reduce both intensity and duratio n of a headache. Index of the Quality of Life in the patients with migraine was increased in the groups treated with either amitriptyline or fluoxetin e, but not in a group treated with maprotiline. The results obtained agree with the notion about high efficiency of antidepressants given between migr aine attacks. Amitriptyline and fluoxetine were more efficient in preventiv e therapy than maprotiline. These findings suggested indirectly, that the e fficiency of antidepressants in treatment of migraine is explained by inhib ition of serotonin reuptake and by 5-HT2-receptor antagonism, while influen ce on the inhibition of noradrenaline reuptake was not so significant.