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Serotonin–norepinephrine reuptake inhibitors for the prevention of migraine and vestibular migraine: a systematic review and meta-analysis
  1. Fengzhi Wang1,2,
  2. Jiaoqi Wang1,
  3. Yumeng Cao2 and
  4. Zhongxin Xu1
  1. 1Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
  2. 2Neurology, People's Hospital of Liaoning Province, Shenyang, Liaoning, China
  1. Correspondence to Dr Zhongxin Xu, Neurology, China-Japan Union Hospital of Jilin University, Changchun 130031, China; xuzhongxin9999{at}


Background and objectives 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. We aimed to perform an updated review focusing on the efficacy and tolerability of SNRIs for migraine and VM prevention.

Methods We searched the PubMed, Web of Science, and Cochrane Library databases for relevant studies. The primary outcome was migraine frequency. In the case of VM, the Dizziness Handicap Inventory (DHI) scores and Vertigo Severity Scores (VSSs) were extracted.

Results Six randomized controlled trials involving 418 patients were analyzed. 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). We 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.

Conclusions SNRIs were clinically safe and effective for migraine and VM 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.

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  • Contributors Study design: FW and ZX. Acquisition of data: FW and JW. Analysis and interpretation of data: FW and YC. Drafting of the manuscript: FW, JW, and YC. Critical revision of the manuscript: ZX. All authors read and approved the final manuscript.

  • Funding This work was funded by the Natural Science Foundation of Liaoning Province (20180550675).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data can be obtained from the included studies.