Comparative efficacy and safety of tricyclic antidepressants vs. serotonin-norepinephrine reuptake inhibitors for migraine prophylaxis: A systematic review and meta-analysis
Abstract
INTRODUCTION
Migraine is a leading cause of global disability, yet research on prophylactic interventions remains limited due to unclear underlying mechanisms. We performed a systematic review and meta-analysis to evaluate the comparative efficacy and safety of tricyclic antidepressants (TCAs) versus serotonin-norepinephrine reuptake inhibitors (SNRIs) for migraine prophylaxis.
METHODS
A systematic review was executed in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane Central databases were searched from inception to December, 2024 for randomized controlled trials (RCTs) comparing selective norepinephrine reuptake inhibitors (SNRIs) with tricyclic antidepressants (TCAs) in migraine patients. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the RoB 2 tool. A random-effects model was applied to pool effect estimates, reporting mean differences (MD) and risk ratios (RR) with 95 % confidence intervals (CIs), using Review Manager v.5.4.
RESULTS
Out of 4253 screened articles, a total of three randomized trials met the inclusion criteria, encompassing 333 patients (mean age 32.4 years, 68 % female) with a mean follow-up of 10 weeks. Both SNRI and TCA groups reduced monthly migraine days (MMD) compared to baseline, with no significant difference between them (MD = -0.03, 95 % CI: -0.67-0.61; p = 0.93). However, SNRIs demonstrated a marginally greater reduction in migraine attack duration (MD = -0.71, 95 % CI: -1.41 to -0.01;…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 333 participants or records.
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