Treatment with Mirtazapine, also known as Combar

The medication 

Mirtazapine was developed to treat depression, but it has since been shown to also have an effect on chronic tension-type headaches. When this medication is prescribed for 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 headaches. 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 your metabolism, but it can increase your 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 during the initial phase of treatment. 

Before starting treatment

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

What is the recommended dosage 

Usually, you start by taking 15 mg 1-2 hours before bedtime for one week. After that, 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.