Duloxetine (Cymbalta) is an antidepressant in the family of serotonin-norepinephrine reuptake inhibitors (SNRIs). Unlike the selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), escitalopram (Lexapro) and other, SNRIs not only treat depression and anxiety, but also relieve pain and prevent migraine headaches.
Duloxetine is specifically approved by the FDA for the treatment of major depression, generalized anxiety, musculoskeletal pain, such as low back pain and pain due to osteoarthritis, as well as pain of fibromyalgia and diabetic peripheral neuropathy.
Duloxetine is not officially approved for the treatment of migraine headaches, but it is been widely for this indication. There are no large controlled trials, but several small studies show that it may be effective even for chronic migraines with medication overuse. Most studies employed a dose of 60 mg, but one study suggested that high doses of the drug (120 mg) may be more effective for the prevention of episodic migraine headaches.
Considering that duloxetine is proven to relieve pain of different types, it is very likely that it is effective for the prevention of migraines as well. It is particularly a good choice in patients with comorbid anxiety and depression and these conditions are 2-3 times more likely to occur in migraine sufferers.
Potential side effects include insomnia, drowsiness, fatigue, nausea, dizziness, suicidal thoughts in depressed children and young adults, and other
Sudden discontinuation of duloxetine can cause withdrawal symptoms, which may consist of one or more of the following symptoms: dizziness, headache, nausea, diarrhea, paresthesia (pins-and-needles), irritability, vomiting, insomnia, anxiety, sweating, and fatigue. These can be avoided by a very gradual reduction in the dose. On occasion, when the dose is down to the smallest size capsule of 20 mg, stopping it can cause withdrawal symptoms. In such cases I advise the patient to open the capsule and to discard ever increasing amounts of the drug for a period of a week or two.
