Can Wellbutrin (bupropion) be used to treat migraines?

Wellbutrin (Bupropion) for Migraine Treatment

Wellbutrin (bupropion) is not recommended for the treatment of migraine headaches as it is not included in any of the evidence-based guidelines for migraine management. 1

First-Line Treatments for Migraine

According to the American College of Physicians and American Academy of Neurology guidelines, the recommended treatments for acute migraine episodes include:

Acute Treatment Options:

• First-line treatments:

  • NSAIDs (ibuprofen, naproxen)
  • Acetaminophen
  • Combination of NSAID + acetaminophen
  • Triptans (sumatriptan, rizatriptan, eletriptan)
  • Aspirin-acetaminophen-caffeine combinations 1, 2

• Second-line treatments:

  • CGRP antagonists (gepants) such as rimegepant, ubrogepant, or zavegepant
  • Antiemetics when nausea is prominent 1, 2

Preventive Treatment Options:

For patients experiencing ≥2 migraines per month or disabling attacks, preventive therapy should be considered with:

• First-line preventive medications:

  • Beta-blockers (propranolol 80-240 mg/day, timolol 20-30 mg/day)
  • Amitriptyline (30-150 mg/day)
  • Divalproex sodium (500-1500 mg/day)
  • Sodium valproate (800-1500 mg/day)
  • Topiramate (100 mg/day) 1

• Second-line preventive options:

  • CGRP antagonists (erenumab, fremanezumab, galcanezumab)
  • Venlafaxine
  • Gabapentin
  • Naproxen
  • Natural supplements (butterbur root, vitamin B2, magnesium) 1, 3

Why Wellbutrin Is Not Recommended

Wellbutrin (bupropion) is notably absent from all migraine treatment guidelines. While some antidepressants like amitriptyline (a tricyclic antidepressant) and venlafaxine (an SNRI) have demonstrated efficacy in migraine prevention, bupropion has not shown similar benefits in clinical studies 1, 4.

The American Family Physician and expert guidelines specifically mention tricyclic antidepressants and SNRIs as potentially effective for migraine prevention, but not bupropion, which works through different mechanisms (primarily dopamine and norepinephrine reuptake inhibition) 4.

Antidepressants with Evidence for Migraine Treatment

If considering an antidepressant for migraine prevention:

• Amitriptyline has the strongest evidence and is considered first-line 1, 4
• Venlafaxine and duloxetine (SNRIs) have moderate evidence and may be particularly beneficial for patients with comorbid depression and migraine 4
• SSRIs including fluoxetine are generally not effective for most migraine patients 4

Important Clinical Considerations

• Medication overuse can lead to rebound headaches: limit NSAIDs to ≤15 days/month and triptans to ≤10 days/month 1
• Allow 6-8 weeks at therapeutic dose to assess effectiveness of preventive medications 1
• Target a 50% reduction in attack frequency when using preventive therapy 1
• Be cautious with triptans in patients with cardiovascular risk factors 1
• Lifestyle modifications (regular sleep schedule, consistent meals, hydration, physical activity) should be recommended for all patients 1

In conclusion, while certain antidepressants have proven efficacy in migraine treatment, Wellbutrin (bupropion) is not among them and should not be used for this purpose when evidence-based alternatives are available.