Treatment with Mirtazapine, also known as Combar

The preparation

Mirtazapine was developed to treat depression, but it has later been shown to also have an effect on chronic tension-type headaches. When the medication is prescribed to you, it is therefore not to achieve an antidepressant effect, but because mirtazapine may hopefully improve your headaches.

Effect

Mirtazapine increases the concentration of pain-relieving substances in the central nervous system and provides a more restful night's sleep, which is likely the reason for its preventive effect against headaches.

Mirtazapine does not eliminate the headache. A realistic treatment goal is a 30% reduction in headaches. However, there is a great deal of individual variation in how well it works.

Side effects

The most common side effects are fatigue, dry mouth, and weight gain. Alcohol can intensify the sedative effect. Mirtazapine does not affect metabolism, but it can increase appetite. You can therefore counteract weight gain by eating as usual and monitoring your weight regularly.

Precautions

Alcohol can intensify the sedative effect.

You should be careful when driving at the start of treatment.

Before starting treatment

Before you start treatment with mirtazapine, you must have an electrocardiogram (ECG) taken.

What is the dosage?

Normally, you start by taking 15 mg 1-2 hours before bedtime for one week. Thereafter, 30 mg before bedtime.

If there is a good effect and no overly bothersome side effects, this dose is taken for 6 to 12 months, after which the dose can be tapered off in consultation with your doctor. Some patients, however, need to take mirtazapine for a longer period. If there is no effect after 1-2 months, it can be concluded that mirtazapine does not work for you, and you can taper down to 15 mg for one week and then stop the medication completely.