A male patient born 1948 with a depressive disease was instituted on treatment with 20 mg citalopra

Fråga: A male patient born 1948 with a depressive disease was instituted on treatment with 20 mg citalopram (Cipramil) but after one tablet the patient had a severe headache in the morning. The patient is known to suffer from migraines. The questions are: 1) can citalopram cause migraines; 2) can sumatriptan (Imigran) be given to treat the headache caused by citalopram?

Sammanfattning: The combination of citalopram and sumatriptan should be avoided. Citalopram may cause headache as side-effect both non-migraine as well as migraine like headache.

Svar: The second part of the question is answered first. Unless the patient has a migraine which is intractable to standard treatment there is no indication for treatment with Imigran. Furthermore, according to the Swedish Physicians Desk Top Reference, FASS (1), there may be an interaction where citalopram may increase the effect of sumatriptan, hence, increasing the risk of side-effects due to this compound. Concerning a possible interaction between citalopram and sumatriptan see enclosed Drugline document for further information (2).

Citalopram is, like most other drugs, known to cause headache in a proportion of patients. Fifteen reports of headache were found in the Swedish Adverse Reaction Register Swedis and two reports of migraine have been located (3). 1 FASS 1995 2 Drugline nr 11932 (year 1995) (enclosed) 3 Swedis