By Marcello Cherchi, MD PhD
For patients
Venlafaxine helps some people with migraine. It may make migraines happen less often, or make them shorter, or make them less severe.
For clinicians
Overview
Venlafaxine is a serotonin-norepinephrine reuptake inhibitor originally designed for psychiatric purposes, but used off-label for several disorders, including migraine. In the relatively low doses used for migraine prophylaxis, venlafaxine is generally well-tolerated.
Introduction
Venlafaxine is classified as an SNRI (serotonin-norepinephrine reuptake inhibitor). Venlafaxine has been FDA approved for the treatment of major depressive disorder, generalized anxiety disorder, social anxiety disorder and panic disorder, though it has also found numerous off-label uses (e.g., migraine prophylaxis, management of menopausal symptoms).
Pharmacology
Venlafaxine is classified as a serotonin and norepinephrine reuptake inhibitor (SNRI), though it additionally inhibits reuptake of dopamine (Holliday and Benfield 1995; Wellington and Perry 2001).
Adverse effects
When venlafaxine is used for otoneurological purposes such as migraine prophylaxis, it is generally deployed at doses lower than those used for treating psychiatric conditions, consequently its side effect profile at the lower dose tends to be more favorable. At the doses used in otoneurology, the most common adverse effects include dyspepsia, jitteriness and (if taken before bedtime) insomnia.
Cautions and contraindications
Venlafaxine should not be taken during pregnancy and lactation. Venlafaxine should be used cautiously in patients on other medications that potentiate serotonin or norepinephrine.
Relevance in otoneurology
The main application of venlafaxine in otoneurology is probably in the management of migraine with migraine associated vertigo. For the purpose of migraine prophylaxis, venlafaxine was shown to be superior to placebo (Ozyalcin et al. 2005), not inferior to amitriptyline (Hedayat et al. 2022), equivalent to propranolol (Salviz et al. 2016), and similar to flunarizine and valproate (Liu et al. 2017). Venlafaxine is generally well-tolerated, and appears to be better tolerated than tricyclic compounds such as amitriptyline (Bulut et al. 2004; Hedayat et al. 2022).
References
Bulut S, Berilgen MS, Baran A, Tekatas A, Atmaca M, Mungen B (2004) Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study. Clin Neurol Neurosurg 107: 44-8. doi: 10.1016/j.clineuro.2004.03.004
Hedayat M, Nazarbaghi S, Heidari M, Sharifi H (2022) Venlafaxine can reduce the migraine attacks as well as amitriptyline: A noninferiority randomized trial. Clin Neurol Neurosurg 214: 107151. doi: 10.1016/j.clineuro.2022.107151
Holliday SM, Benfield P (1995) Venlafaxine. A review of its pharmacology and therapeutic potential in depression. Drugs 49: 280-94. doi: 10.2165/00003495-199549020-00010
Liu F, Ma T, Che X, Wang Q, Yu S (2017) The Efficacy of Venlafaxine, Flunarizine, and Valproic Acid in the Prophylaxis of Vestibular Migraine. Front Neurol 8: 524. doi: 10.3389/fneur.2017.00524
Ozyalcin SN, Talu GK, Kiziltan E, Yucel B, Ertas M, Disci R (2005) The efficacy and safety of venlafaxine in the prophylaxis of migraine. Headache 45: 144-52.
Salviz M, Yuce T, Acar H, Karatas A, Acikalin RM (2016) Propranolol and venlafaxine for vestibular migraine prophylaxis: A randomized controlled trial. Laryngoscope 126: 169-74. doi: 10.1002/lary.25445
Wellington K, Perry CM (2001) Venlafaxine extended-release: a review of its use in the management of major depression. CNS Drugs 15: 643-69. doi: 10.2165/00023210-200115080-00007
