頭痛治療の三環系抗うつ薬のシステマティックレビューとメタ分析

　偏頭痛の罹患頻度は、全世界で8.4から18%と報告されているようです。三環系抗うつ薬は、1964年に最初に予防効果について報告があり、頭痛の予防についてのメタ分析では緊張性頭痛も片頭痛にも効果があることがわかっています。今回は、治療効果についてメタ分析の報告です。

　偏頭痛と緊張性頭痛はプラセボ比較で効果でしたが、SSRIとの比較では有意差はありませんでした。

	average standardised mean difference	95% confidence interval
緊張性頭痛	−1.29	−2.18 to −0.39
偏頭痛	−0.70	−0.93 to −0.48
SSRI	−0.80	−2.63 to 0.02

副作用は、三環系抗うつ薬はプラセボ比較で高く(1.53, 95% confidence interval 1.11 to 2.12)、SSRI比較でも高い (2.22, 1.52 to 3.32),dry mouth, drowsiness, weight gainで有意差があったが、中断については差がなかった。

BMJ 2010; 341:c5222
Tricyclic antidepressants and headaches: systematic review and meta-analysis

Objective To evaluate the efficacy and relative adverse effects of tricyclic antidepressants in the treatment of migraine, tension-type, and mixed headaches.
Design Meta-analysis.
Data sources Medline, Embase, the Cochrane Trials Registry, and PsycLIT.
Studies reviewed Randomised trials of adults receiving tricyclics as only treatment for a minimum of four weeks.
Data extraction Frequency of headaches (number of headache attacks for migraine and number of days with headache for tension-type headaches), intensity of headache, and headache index.
Results 37 studies met the inclusion criteria. Tricyclics significantly reduced the number of days with tension-type headache and number of headache attacks from migraine than placebo (average standardised mean difference −1.29, 95% confidence interval −2.18 to −0.39 and −0.70, −0.93 to −0.48) but not compared with selective serotonin reuptake inhibitors (−0.80, −2.63 to 0.02 and −0.20, −0.60 to 0.19). The effect of tricyclics increased with longer duration of treatment (β=−0.11, 95% confidence interval −0.63 to −0.15; P<0.0005). Tricyclics were also more likely to reduce the intensity of headaches by at least 50% than either placebo (tension-type: relative risk 1.41, 95% confidence interval 1.02 to 1.89; migraine: 1.80, 1.24 to 2.62) or selective serotonin reuptake inhibitors (1.73, 1.34 to 2.22 and 1.72, 1.15 to 2.55). Tricyclics were more likely to cause adverse effects than placebo (1.53, 95% confidence interval 1.11 to 2.12) and selective serotonin reuptake inhibitors (2.22, 1.52 to 3.32), including dry mouth (P<0.0005 for both), drowsiness (P<0.0005 for both), and weight gain (P<0.001 for both), but did not increase dropout rates (placebo: 1.22, 0.83 to 1.80, selective serotonin reuptake inhibitors: 1.16, 0.81 to 2.97).
Conclusions Tricyclic antidepressants are effective in preventing migraine and tension-type headaches and are more effective than selective serotonin reuptake inhibitors, although with greater adverse effects. The effectiveness of tricyclics seems to increase over time.

これから）月曜日のはじまりは重たいですね。