Using Celexa to Prevent Migraines

Citalopram (brand name Celexa) is a type of antidepressant called a selective serotonin reuptake inhibitor, or SSRI, that is generally used to treat depressive and anxiety disorders. In some cases, a healthcare provider will also prescribe Celexa or another SSRI option to prevent migraines. This is considered an off-label use, meaning it has not been approved by the U.S. Food and Drug Administration (FDA). Often, the drug is prescribed for people who suffer from both migraines and depression.

How It Works

Citalopram, like all SSRIs, works by making more of the neurotransmitter serotonin available between nerve cells. Higher levels of serotonin have been shown to ease depression.

The rate of depression in people with migraines is higher than in the general population, but the exact relationship between the two is not entirely clear. Migraines may cause depression, depression may contribute to migraines, or there may be some common underlying vulnerability to both.

Furthermore, there is no robust scientific data confirming the effectiveness of Celexa or any other formulation of citalopram for preventing migraines.

In fact, a 2015 review found that SSRIs—including Celexa—were no more effective than placebo or amitriptyline (a tricyclic antidepressant) in reducing headache frequency in patients with chronic tension-type headaches or migraines.

Still, if you do have depression and migraines, it may be worth a try.

Formulation and Uses

Citalopram, whether the generic drug or Celexa, is available in tablet and liquid form and can be taken with or without food.

In addition to possibly preventing migraines, citalopram has been found to be helpful for obsessive-compulsive disorder, panic disorder, social phobia (also known as social anxiety disorder), post-traumatic stress disorder, eating disorders, and premenstrual dysphoric disorder.

Citalopram has not been officially FDA-approved for use in children and adolescents, although it is sometimes used off-label in these populations to treat depression and anxiety.

Dosing

Citalopram tablets come in dosages of 20 milligrams (mg) and 40 mg; the liquid form delivers 10 mg per 5 milliliters (mL).

In general, patients are started on a dose of between 10 to 20 mg once a day. Your healthcare provider may eventually decide to increase the dosage, with 40 mg being the maximum dose in most cases.

Citalopram, like all SSRIs, can take several weeks to reach its full effect. Always take it at the same time every day, and never alter your dose without your healthcare provider's permission. If you forget to take a dose, take it as soon as you remember, but don't take a double dose to make up for the missed one.

Adverse Effects

Citalopram, like all SSRIs, can have side effects. The most common ones include:

• Headache
• Nausea
• Diarrhea
• Dry mouth
• Increased sweating
• Feeling nervous or restless
• Feeling sleepy or having trouble sleeping (insomnia)

These will often improve over the first week or two as you continue to take the medication.

Sexual side effects, such as problems with libido, orgasm, or ejaculation, are also common and may require changes in medication.

Rare and/or serious side effects include:

• Increased bleeding
• Low sodium blood levels: Symptoms may include headache, weakness, difficulties with memory, and concentration or seizures.
• Angle closure glaucoma: Symptoms may include eye pain, changes in vision, swelling or redness in or around the eye.

Serotonin Syndrome: A Life-Threatening Complication

Serotonin syndrome is a serious condition that's caused by elevated serotonin concentrations in your system. This can be caused by an overdose of an SSRI or by taking a combination of drugs that increases serotonin levels.

Symptoms of serotonin syndrome include:

• Slow or fast pulse
• Fever
• Headache
• Muscle rigidity
• Confusion
• Profuse sweating
• Tremor
• Dilated pupils
• Poor coordination
• Rapid breathing
• Irregular heartbeat
• High blood pressure
• Shivering

In the most severe cases, serotonin syndrome can cause coma, seizures, and even death.

If you suspect you or a loved one may have serotonin syndrome, call your healthcare provider or head to the emergency room immediately.

Warning

Citalopram is used to treat depression, but there is a risk that it can cause worsening of mood symptoms, especially at the outset of treatment.

There is an increased risk of suicidal thoughts and behaviors in children, teenagers, and young adults under age 24 associated with Celexa. For this reason, there is a black box warning on the patient information that comes with the prescription.

Interactions

Migraine medications called triptans, including Zomig (zolmitriptan) and Maxalt (rizatriptan), may increase the risk of serotonin syndrome when taken with citalopram. Be sure to tell your healthcare providers if you take a triptan.

Other drugs that may interact dangerously with citalopram include:

• Monoamine oxidase inhibitors (MAOIs), including Nardil (phenelzine), Parnate (tranylcypromine), and Marplan (isocarboxazid)
• Orap (pimozide), an antipsychotic (potential cardiac issues)

Citalopram may also increase the risk of bleeding, particularly when used with other blood thinners such as aspirin or Coumadin (warfarin).

Contraindications

There haven’t been enough studies done on citalopram use in humans to be certain how the drug might affect a fetus. Citalopram passes into breast milk in small amounts.

Talk to your healthcare provider if you’re pregnant, planning to become pregnant, or are breastfeeding so you can weigh the risks and benefits of taking Celexa or its generic.

A Word From Verywell

If your healthcare provider offers Celexa (citalopram) as a way to prevent your migraines—whether you have depression or not—be sure to tell him or her your complete medical history, as well as provide a list of all your medications, including over-the-counter drugs and supplements. This is the best way to ensure any safety concerns can be addressed.