Professional and Linguistic Assessments Board (PLAB) Practice Exam

What antidepressant is often used as a preventative measure in migraine and cluster headache?

1. Amitriptyline

2. Venlafaxine

3. Fluoxetine

4. Duloxetine

The correct answer is: Amitriptyline

Amitriptyline is frequently used as a preventative treatment for migraine and cluster headaches due to its ability to modulate pain pathways and its effect on neurotransmitter levels, including serotonin and norepinephrine. It is a tricyclic antidepressant that can help reduce the frequency and severity of headaches when administered at low doses, which is beneficial in managing chronic headache conditions. The mechanism by which amitriptyline exerts its effects involves blocking certain receptors and reuptake transporters, leading to increased levels of neurotransmitters in the synaptic cleft, contributing to its analgesic properties. This is especially effective in patients who experience frequent migraine attacks or cluster headaches, as the preventive approach helps minimize the occurrence of these debilitating episodes. While other antidepressants, such as venlafaxine, fluoxetine, and duloxetine, have varying degrees of effectiveness in treating depression and certain pain conditions, they are not typically the first-line options for migraine or cluster headache prevention. Thus, amitriptyline stands out as the preferred choice due to its established efficacy in reducing headache frequency and improving the quality of life for patients suffering from these conditions.