1. A randomized controlled trial of citalopram on migraine frequency Satnam S. Nijjar, M.D. Department of Neurology, Johns Hopkins School of Medicine

2. Burden of Migraine Migraine is highly prevalent: 7.8 % in males and 24.9% in females Migraine has significant impact on the sufferer and on society Estimated cost of $13 billion/year in U.S. –Absenteeism –Reduced effectiveness

3. Need for improved prophylaxis No clear first line therapy. Decreased serotonin levels implicated, however little evidence to support selective serotonin reuptake inhibitors. Citalopram is a well established SSRI with a well known safety profile.

4. Hypothesis Citalopram will significantly reduce the frequency of episodic migraine compared to placebo in patients who are candidates for migraine prophylaxis.

5. Study Design Citalopram 20 mg daily Placebo Randomization 3 months6 months (primary outcomes) = Data Visit 1 month consent and initial intake

6. Study Population Inclusion criteria –Episodic migraine as defined by International Headache Society –Candidates for prophylaxis, not on previous treatment Exclusion criteria –chronic migraine –analgesic overuse – antidepressant therapy Recruitment –Approximately 100 adult patients –Headache Clinic – Johns Hopkins Bayview Medical Center

7. Variables Primary outcome: migraine frequency as assessed by diary Secondary outcomes: –Disease specific: Migraine Disability Assessment Scale (MIDAS) and Headache Impact Test (HIT) survey scores –Quality of Life: SF-36 survey scores Safety variables –Symptom questionnaire

8. Statistical Analysis Intention to treat analysis Analytic steps –Calculate rates (episodes/month) –Compare rates Ratio of rates Difference of rates

9. Significance Demonstrating the effectiveness of citalopram in migraine prophylaxis may alter current practice Providing clinicians with a new avenue of migraine treatment with a low side effect profile.

10. Acknowledgements Group Instructors: –Dr. Larry Appel –Dr. Liz Selvin –Dr. Mark Woodward Group Members: –Dr. Liudmila Cebotaru, Dr. Ralph Daher, Dr. Andrea Dugas, Dr. Christopher Ennen, Dr. Shannon Haley, and Dr. Milap Nowrangi

11. Thank you