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Zoloft (Sertraline) & Headaches: Does It Cause or Treat Headaches?

Zoloft (Sertraline), is an SSRI (selective serotonin reuptake inhibitor) prescribed for the treatment of major depressive disorder, OCD (obsessive-compulsive disorder), panic disorder, and social anxiety disorder.  It was approved by the FDA in 1991 and initially marketed by the pharmaceutical company Pfizer.  In 2013, Zoloft became the single most popular antidepressant medication in the United States with over 41 million prescriptions filled throughout the year.

If compared to other antidepressant medications, evidence suggests that Zoloft is similar in both effectiveness and tolerability.  Through its ability to inhibit the reuptake of serotonin within the brain, Zoloft can treat a variety of neuropsychiatric conditions.  Additionally, there’s preliminary evidence suggesting that Zoloft may prove useful as a treatment for headaches.

Conversely, many individuals claim that Zoloft actually causes them to experience bad headaches as a side effect.  It seems as though whether Zoloft helps to treat headaches or causes headaches as a side effect is subject to significant individual variation.  This article will discuss why Zoloft might help treat headaches in a subset of persons, yet cause headaches in others.

How often do headaches occur as a Zoloft side effect?

Research suggests that headache is one of the most common side effects of Zoloft (along with nausea, diarrhea, dry mouth, insomnia, somnolence, tremor, headache, and sexual dysfunction).  According to data compiled by Murdoch & McTavish (1992), the aforementioned side effects (one of which is headaches) will occur in 10% to 20% of patients.  That said, the percentage of patients that specifically end up with headaches as a side effect remains unknown.

According to research from Cipriani, La Ferla, Furukawa, et al. (2009), sertraline is associated with approximately 1.6-fold increased likelihood of headache as a side effect compared to tricyclic antidepressants.  The finding that sertraline increases odds of headache compared to tricyclic antidepressants was derived from 5 trials with 1090 participants in which sertraline was compared to amitriptyline.  However, because amitriptyline is used as first-line agent to treat headaches, this finding shouldn’t be surprising.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/1281075
  • Source: https://www.ncbi.nlm.nih.gov/pubmed/19370626

Zoloft (Sertraline) & Headaches: Possible Causes of this Side Effect

If you experience headaches while taking Zoloft, listed below are some potential causes.  That said, you should know that the specific causes of headache on Zoloft will be subject to significant individual variation.  A subset of Zoloft users might experience headaches specifically as a result of medication-induced changes in cerebral blood flow, whereas other individuals might experience headaches as a result of changes in the neurotransmission of serotonin – or a combination of blood flow and neurotransmitter changes.

  • Adaptation to Zoloft: Many individuals may experience headaches as a transient Zoloft side effect in the first few months after treatment commencement. During the first few weeks or months of treatment, the brain and central nervous system are undergoing adaptation to the presence of Zoloft and its neurochemical effects.  While undergoing adaptation, there may be changes in neurotransmitter levels, receptor densities, regional blood flow, and regional activation – each of which, or the combination of which, could potentially induce headaches.  If you just started taking Zoloft, this adaptation phase of treatment might account for your headaches.  Continuing to use Zoloft for several months may cause the headaches to abate if they were initially related to lack of physiologic adaptation to the medication.
  • Administration timing: It’s possible that the timing at which you administer Zoloft might be culpable for triggering headaches as a side effect as a result of an interaction with circadian biology. It is understood that circadian biology influences the production of hormones and neurotransmitters throughout the body at different times of day.  This considered, it’s reasonable to speculate that individualized circadian rhythms may increase or decrease likelihood of headaches as a side effect of Zoloft based on its timing of administration.  For one person, administering Zoloft before bed might increase likelihood of headaches, yet for another person taking Zoloft before bed may decrease odds of headaches – largely due to medication-circadian biology interactions.
  • Cerebral blood flow: It is documented that SSRI antidepressants like Zoloft can alter cerebral blood flow in throughout the brains of users. Evidence suggests that Zoloft and other SSRIs often significantly increase cerebral blood flow in the prefrontal cortex.  Moreover, some individuals may experience decreased cerebral blood flow as a result of SSRI-induced vasoconstriction; this is a rare adverse effect.  Because significant changes in cerebral blood flow can induce headache and migraine, it’s possible that Zoloft-mediated cerebral blood flow change is a cause of headache.
  • Dosage adjustments: Anytime you increase or decrease your Zoloft dosage, it takes time for your brain and body to adapt to the new dose. If you increase the dosage, you’re ingesting a greater quantity of sertraline, which in turn, alters brain activity to a greater extent than lower dosages.  More specifically, alterations in neurotransmission and cerebral blood flow due to lack of adaptation to the increased dosage may explain the headaches.  Oppositely, if the Zoloft dosage was recently decreased, neurophysiologic adjustments may take place such that headache occurs as a symptom of withdrawal from the larger dose.
  • Interaction effects: If you’re using Zoloft with other medications and/or supplements or mixing Zoloft and alcohol, there’s a chance that Zoloft might be interacting with the other substance(s) to cause your headache. Zoloft might interact with the other substance(s) during metabolism (i.e. pharmacokinetically) or within the body (i.e. pharmacodynamically) to increase likelihood of headache.  For example, if Zoloft and another substance synergistically alter cerebral blood flow or neurotransmission, the synergistic effects might be the cause of your headaches.
  • Missed doses: If you accidentally skip a dose of Zoloft or mistime your dosing, you may experience headaches as a result of withdrawal. The effects of a single Zoloft pill are suggested last for a total of 24 hours.  If you forget to take your Zoloft dose, your body enters an early stage of Zoloft withdrawal whereby headache can occur as a withdrawal symptom.  Resuming your medication as soon as possible and adhering to a dosing schedule can minimize likelihood of headache throughout treatment.
  • Neural connectivity: Evidence from neuroimaging studies suggests that SSRIs like Zoloft can alter brain connectivity within just 3 hours of treatment. Specifically, SSRI medications appear to decrease neural connections in most regions of the brain with the exception of the thalamus and cerebellum.  In the thalamus and cerebellum, connectivity significantly increases after antidepressant administration.  Other research indicates that SSRIs substantially modulate functional connectivity in the anterior cingulate cortex (ACC) and limbic regions.  Based on the fact that Zoloft changes the connections within your brain, we must consider that this is another potential cause of headache.
  • Neurotransmitter levels: Zoloft is understood to function as a selective-serotonin reuptake inhibitor whereby it increases serotonin levels extracellularly. Research suggests that the neurotransmitter serotonin is implicated in the pathogenesis of many types of headaches, including migraine and tension-type.  It’s possible that, for a subset of persons, using Zoloft could alter serotonergic transmission throughout the brain in ways that increase susceptibility to headache.
  • Oxidative stress increase: Some research suggests that high-dose Zoloft administration significantly increases levels of oxidative stress. It is known that high oxidative stress may play a role in headache or migraine pathogenesis.  For this reason, it’s fair to suspect that Zoloft-induced oxidative stress could trigger headaches in susceptible individuals.
  • Regional activity: In addition to modifying neural connectivity, Zoloft and other SSRIs appear to alter activation of various brain regions. It is understood that antidepressants increase activation of the prefrontal cortex, a brain region that’s often underactive among persons with depression.  Additionally, antidepressants also appear to decrease hyperactivity or overactivation within the limbic regions of the brain.  That said, the regional activity changes induced by Zoloft might cause headaches for a subset of users.
  • Side effects: Even if Zoloft doesn’t directly cause headaches, it’s possible that other Zoloft side effects might provoke or increase likelihood that headaches will occur. For example, insomnia is a common side effect of Zoloft that might interfere with your sleep quality.  If you’re getting less sleep or worse sleep while using Zoloft as a result of insomnia (as a side effect), this might indirectly provoke headaches.
  • Withdrawal from Zoloft: If you’re tapering off of Zoloft or withdrawing from Zoloft, you may experience headaches as a Zoloft withdrawal symptom. During withdrawal from the medication, headaches can be triggered by many things, including: neurotransmitter adjustments, blood flow changes, poor sleep, electrolyte imbalances, high anxiety, hormone changes, etc.

Note: Experiencing headaches while taking Zoloft might also be a coincidence rather than a side effect.  For example, if while taking Zoloft you: are exposed to high stress, aren’t getting proper sleep, are dehydrated, aren’t eating enough calories, or aren’t consuming a nutritious diet – these could explain your headache.  If you aren’t living a healthy lifestyle, it may be difficult to know whether your headaches are legitimately attributable to Zoloft.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/8588061
  • Source: https://www.ncbi.nlm.nih.gov/pubmed/15641869
  • Source: https://www.ncbi.nlm.nih.gov/pubmed/26412065
  • Source: https://www.ncbi.nlm.nih.gov/pubmed/24610613

How Zoloft Might Treat Headaches…

Not everyone will experience headaches as a side effect of Zoloft.  In fact, preclinical evidence suggests that Zoloft may prove efficacious as a treatment for tension-type headaches, regardless of comorbid neuropsychiatric conditions.  In other words, some individuals will find that Zoloft prevents or reduces the frequency and/or severity of headache or migraine.  Though the exact mechanism(s) by which Zoloft might treat headaches is unknown, below are a few possibilities.

  • Anxiety reduction: One obvious way in which Zoloft may treat or prevent headaches is by reducing anxiety and stress. As a selective-serotonin reuptake inhibitor, Zoloft upregulates concentrations of extracellular serotonin to treat anxiety disorders.  Untreated anxiety disorders and/or stress increase one’s risk of experiencing tension-type headaches and migraine.  High anxiety can disrupt electrolyte, neurotransmitter, and hormone levels, as well as alter blood flow within the brain to trigger headaches.  Assuming Zoloft effectively treats your anxiety, this may be reason as to why it also alleviates headaches.
  • Brain activation changes: As was mentioned, ongoing Zoloft treatment alters many aspects of brain activity, including: cerebral blood flow, neural connectivity, neurotransmission, and regional activation. It’s possible that brain activity changes attributable to Zoloft administration might protect against headache.
    • Blood flow: Treatment with Zoloft can alter blood flow within the brain. Modulation of blood flow to certain regions of the brain might prevent or minimize the severity of headaches.
    • Neural connectivity: Treatment with Zoloft can alter neural connectivity (connections between brain regions). Modulation of neural connectivity in certain areas of the brain might help treat headaches.
    • Neurotransmission: Zoloft functions by inhibiting the reuptake of serotonin within the brain. Because serotonin irregularities may play a role in headache and/or migraine, normalizing serotonin levels with Zoloft might help treat headaches.
    • Regional activation: Zoloft can increase activity in certain regions of the brain and decrease activity in others. It’s possible that modulation of regional activity via Zoloft could help reduce headache frequency and/or severity.
  • Depression treatment: Untreated depression is associated with increased risk of experiencing tension-type headaches. Some evidence also suggests that depressive disorders may increase risk of migraine.  If you have headaches with comorbid depression and Zoloft effectively treats your depressive symptoms, this could be the way in which it is alleviating your headache.  In other words, mood enhancement might be the reason you’re experiencing fewer headaches on Zoloft than pre-treatment.
  • Inflammation reduction: Unmanaged neuroinflammation is thought to play a role in the pathogenesis of headache and migraine. This considered, it’s fair to speculate that reducing inflammation might reduce the frequency and/or severity of headaches.  Evidence suggests that taking Zoloft for 12 weeks can decrease systemic inflammation to a significant extent, as evidenced by serum reductions in CRP (C-Reactive Protein) – a biomarker of inflammation.  If your systemic inflammation decreases while using Zoloft, this anti-inflammatory effect may be how the medication is treating your headaches.
  • Sleep enhancement: If before using Zoloft your sleep quality was poor or duration was suboptimal for physiological needs, this may have been reason as to why you were experiencing headaches. Poor sleep can increase inflammation, increase the stress response, modify hormone secretion, and alter many facets of brain activity.  If after taking Zoloft for a while your sleep improves in terms of quality and/or duration, this may be reason as to why you’re experiencing fewer or less severe headaches than usual.

Using Zoloft for Headaches: A Potential Treatment (Research)

It is known that Zoloft was once considered an investigational medication for the treatment of headaches.  In other words, if Zoloft would’ve shown significant promise in managing headaches, perhaps it would’ve undergone clinical trials for the treatment of headaches.  If approved, we might see Zoloft being marketed as a headache medication.  Nevertheless, included below are studies in which the efficacy of Zoloft was examined or discussed for the management of headaches.

2003: Sertraline versus amitriptyline in the prophylactic therapy of non-depressed chronic tension-type headache patients.

Boz, Altunayoglu, Velioglu, et al. noted that individuals with chronic tension-type headache (CTTH) are usually the most challenging to treat.  First-line treatments for chronic tension-type headaches consist primarily of tricyclic antidepressants (TCAs), however, many individuals find them difficult to tolerate due to anticholinergic side effects.  For this reason, the aforementioned researchers sought to determine if sertraline, an SSRI, may prove useful in the prevention of chronic tension-type headaches in non-depressed persons.

A parallel-group randomized study was organized in which the efficacy of sertraline was compared to that of amitriptyline for the prophylaxis of chronic tension-type headaches.  Study participants were monitored for a 4-week baseline period, then were assigned to receive either: 50 mg sertraline (41 patients) or 25 mg amitriptyline (44 patients) – for a 12-week treatment phase.  The efficacies of each intervention were determined based on headache diaries in which the following were documented: occurrence; number; intensity; and duration – of headaches.

Results indicated that both sertraline and amitriptyline significantly decreased headache symptoms and need to use analgesic medications in the first, second, and third months of treatment – compared to baseline recordings.  That said, amitriptyline was significantly superior in reducing headache symptoms and need to use analgesic medications in the second and third months of the study.  In terms of tolerability, recipients of sertraline experienced fewer debilitating side effects.

It was concluded that both sertraline and amitriptyline are effective in the management of chronic tension-type headache.  However, when efficacies are compared, amitriptyline seems to be more effective.  While sertraline may not be as effective as amitriptyline, it still might be of therapeutic value in treating chronic tension-type headaches.

  • Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3452139/

2002: Sertraline in chronic tension-type headache.

Singh and Misra conducted a randomized, double-blinded, placebo-controlled study to evaluate the efficacy of sertraline for the treatment of chronic tension-type headache (CTTH).  The researchers recruited a total of 50 patients who were diagnosed with chronic tension-type headache to participate in a 10-week study.  The first 2 weeks of the study consisted of a run-in phase, the next 4 weeks were the treatment phase, and the final 4 weeks served as a follow-up phase.

The effectiveness of sertraline was determined based upon: headache index scores, analgesic usage (per week), and percentage (%) reduction in headache frequency.  Results indicated that recipients of sertraline exhibited significant reductions in weekly analgesic intakes from ~4.34 to ~1.07 tablets per week, whereas recipients of the placebo did not exhibit significant reductions in weekly analgesic intakes.  That said, headache index scores and percentage reductions in headache frequency did not significantly change among recipients of sertraline.

Researchers concluded that, based on significant reductions in weekly analgesic intakes among sertraline recipients, sertraline may prove therapeutic in the management of chronic tension-type headache.  More specifically, it was stated that sertraline may be a viable alternative to amitriptyline among persons who find amitriptyline to be ineffective or intolerable.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/12126338

1999: Selective serotonin reuptake inhibitors for migraine prophylaxis.

Landy, McGinnis, Curlin, and Laizure sought to determine the therapeutic potential of sertraline in the prevention of migraine.  Researchers organized a study in which 27 adults with a history of migraine participated.  The study begun with a 4-week baseline phase in which migraine frequency and severity were monitored among participants without treatment.

Thereafter, participants were assigned at random to receive either: sertraline or a placebo in double-blinded manner – for a duration of 8 weeks.  The effectiveness of sertraline as a migraine prophylactic was determined based upon daily diaries in which migraine: occurrence, severity, and degree of impairment – were recorded.  Researchers utilized the diary data to determine changes in “headache index” scores or composite scores calculated based upon migraine frequency and severity.

Results indicated that headache index scores did not significantly improve from baseline (~20.8) through week 8 (~17.6) or week 12 (~16.7).  Researchers noted that the finding in this study was similar to findings in which other SSRIs (fluoxetine, fluvoxamine, and paroxetine) were evaluated for migraine prophylaxis.  It was concluded that SSRIs may lack efficacy in migraine prophylaxis, but may offer some therapeutic value among individuals with refractory or treatment-resistant migraine and comorbid depression.

Although this study didn’t find sertraline (Zoloft) to be effective for migraine prevention, there were some serious limitations, including the small sample size (just 6 participants used Zoloft for the full 12-week duration).  Moreover, it’s possible that dosages of sertraline may have been inadequate to effectively prevent migraine.  Due to the small sample size, it’s difficult to confirm that sertraline lacks efficacy in migraine prophylaxis.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/15613191

Based on the research, is Zoloft an effective treatment for headaches?

Possibly.  As of current, data derived from studies in which the efficacy of Zoloft for headache was investigated – are limited.  Moreover, all studies are limited by small sample sizes.  For this reason, it’s difficult to elucidate whether Zoloft is of legitimate therapeutic value in the treatment of headache and/or migraine.

Searching through PubMed, I was only able to dig up 3 studies in which Zoloft was evaluated for the treatment of headache: 2 studies testing it for tension-type headache and 1 study for migraine prevention (i.e. prophylaxis).  If data from existing studies are accurate, it would seem as though administration of Zoloft at 50 mg per day for 4-12 weeks might prove useful in treating chronic tension-type headache – especially among those who respond poorly to first-line interventions.  However, it does not seem as though Zoloft would be useful as a migraine prophylactic.

  • Boz et al. (2003): A study by Boz et al. concluded that sertraline (50 mg per day) was effective in the management of chronic tension-type headache over a 12-week period in patients without depression. Yet when compared to amitriptyline, (a tricyclic antidepressant commonly used to treat headache), Zoloft was significantly less effective.
  • Singh and Misra (2002): A 10-week study by Singh and Misra discovered that ongoing sertraline treatment reduced analgesic intakes from ~4 tablets per week (at baseline) to ~1 tablet per week among individuals with chronic tension-type headache. This finding suggested that Zoloft may be of value in preventing or reducing the severity of chronic tension-type headache.
  • Landy et al. (1999): A well-designed yet very small-scale study by Landy et al. discovered that Zoloft was ineffective as a migraine prophylactic over a 12-week span. However, in this study there were only 6 individuals in the treatment group (using Zoloft for the full 12 weeks).

Using Zoloft for headache or migraine treatment (Possible scenarios)

There are a few scenarios where it may be worth testing the efficacy of Zoloft as a treatment for headache and/or migraine.  The most obvious scenario would be if an individual presented headache plus comorbid anxiety and/or depressive symptoms.  Another scenario might be if an individual reacted poorly to first-line headache medications (in terms of effect or tolerability) – or if the headache is classified as refractory (difficult-to-treat).

  • Comorbid anxiety and/or depression: If you have comorbid anxiety and/or depression with headache or migraine, it may be worth trying Zoloft. Zoloft is frequently prescribed as a first-line intervention for major depressive disorder and anxiety disorders.  If Zoloft is effective for anxiety and/or depression – plus headache – you may be able to use just one medication to manage all of your symptoms rather than using one drug for headache, another for depression, and/or another for anxiety – (which could get difficult to manage and/or increase likelihood of adverse interactions).
  • Chronic tension-type headache: There’s evidence to suggest that Zoloft at a dosage of 50 mg per day may be effective in the treatment of chronic tension-type headache in non-depressed adults. One study found that daily Zoloft administration lead to significant decreases in headache frequency and severity, as well as the need to use analgesic medications (for headache relief) over a 12-week span.
  • Poor response to first-line therapies: If you’ve tested all first-line headache therapies and find them to be ineffective, suboptimally effective, or intolerable – you may need to explore other options like Zoloft. A few studies suggest that Zoloft may be useful as a headache medication among persons who respond poorly to first-line headache therapies.
  • Refractory headache or migraine: If you’ve tested every clinically-recommended medication for the treatment of headache and migraine, yet you aren’t getting symptomatic relief – you may have refractory headache or migraine. Refractory means that your headache or migraine is difficult-to-treat and isn’t responding to conventional therapies.  In this case, you may want to try Zoloft as an off-label intervention based on preliminary evidence suggesting that it might help.

Variables that may influence Zoloft-induced headaches or Zoloft’s efficacy as a headache treatment

There are several variables that may influence whether Zoloft ends up causing headaches, treating headaches, or having zero impact on headaches throughout treatment.  These variables include: concurrent substance use; genetics; lifestyle; duration of Zoloft use; Zoloft dosage; and comorbid medical conditions.  It is the combination of these variables that probably determines whether someone will experience headaches on Zoloft – or get headache relief from it.

  1. Concurrent substance use: If you’re using other substances (medications and/or supplements) along with Zoloft, there’s a chance that the headaches you’re experiencing during treatment might stem from synergistic physiologic effects (induced by Zoloft and another substance). It’s also possible that some sort of pharmacokinetic or pharmacodynamic interaction effect between Zoloft and another medication is to blame for your headaches.  Additionally, if you’re using other substances with Zoloft, it’s possible that the other substance(s) are more culpable for your headache than the Zoloft.  Another possibility is that other substances are the sole reason for your headaches (that you’ve mistakenly assumed are from Zoloft).
  2. Genetics: It is understood that a person’s genetics and epigenetics might determine their risk for headache and migraine. If you do a bit of research, you’ll see that certain genes and phenotypes are associated with increased risk of headache and migraine – whereas others may be protected against headache and migraine.  If you are at high risk of experiencing headaches based on your genes, you might be more likely to experience headaches as a side effect of Zoloft than another user.
  3. Lifestyle & environment: Various lifestyle and environmental factors might also influence whether Zoloft is likely to cause headaches – or its efficacy as a treatment for headaches. Examples of lifestyle and environmental factors include: diet (vitamin/nutrient intake), sleep (quality/quantity), sunlight exposure, artificial light exposure, pollution, exercise, stressors, etc.  Someone living a high stress lifestyle who’s exposed to air pollution and/or noise pollution may experience headaches regardless of the Zoloft.  Oppositely, a low stress lifestyle in an environment devoid of pollution may protect against headaches on Zoloft – or increase its efficacy as a treatment.
  4. Duration of Zoloft use: The total duration over which you’ve used Zoloft might determine whether some individuals experience headaches as a side effect – or find the drug effective in treating headaches. If you’ve only used Zoloft for a short-term, headaches might occur as an adaptation-related side effect.  Moreover, short-term use probably isn’t enough time to derive therapeutic benefit from Zoloft for headache treatment.
  5. Zoloft dosage: Certain dosages of Zoloft might increase odds of experiencing headaches as a side effect – or increase odds that the drug effectively treats headaches. Evidence suggests that a dosage of 50 mg per day seems to be useful in the treatment of tension-type headache.  That said, it is understood that high doses of Zoloft (e.g. above 50 mg) can increase oxidative stress which might provoke headaches.  There’s usually individual variation in terms of dose-responses to Zoloft for the treatment of headaches – and sometimes the occurrence of headaches as a side effect (e.g. headaches might only occur at very high doses for some persons).
  6. Medical conditions: If you have a history of headache and/or migraine, you’ll probably be at increased risk of experiencing headaches during Zoloft treatment. Other medical conditions may also increase your risk of experiencing headache on Zoloft, including OCD.  Some literature suggests that persons with OCD (obsessive-compulsive disorder) tend to experience headaches more frequently while using SSRIs than those without OCD.  Ask your doctor whether preexisting medical conditions may increase or decrease your risk of headache while using Zoloft.

Possible ways to minimize headaches on Zoloft

Though headache is a common side effect of Zoloft, a majority Zoloft users will not experience frequent or severe headaches as a result of the medication.  That said, if you end up with frequent or debilitating headaches while using Zoloft, below are some potential strategies for minimizing their occurrence.  Understand that you should always inform a medical doctor of headaches that you’re experiencing while taking Zoloft.  Moreover, you should never implement any of these headache mitigation strategies without first consulting a medical doctor and verifying that they’re safe and/or potentially useful.

  1. Administration timing: Some individuals may end up with headaches as a side effect of Zoloft because they fail to administer Zoloft at the same time each day. Zoloft is intended to be taken once per day (24-hour period) at the exact same time each day.  If you forget to take your daily dose or mistime your dosing, you may experience headaches as a result of a temporary or mini withdrawal.  Strict adherence to a dosing schedule (e.g. taking Zoloft every day at ~8:00 AM) may help minimize headaches.  Moreover, if you’re experiencing headaches while taking Zoloft in the morning, you may want to try shifting its administration timing to the afternoon or night to see if a different time might help (via circadian-medication interactions).
  2. Adjust your lifestyle: If you’re living a high-stress lifestyle and aren’t attempting to stay healthy, this could be why you’re experiencing headaches on Zoloft. Focus on eating a nutritious diet, stay hydrated, minimize your stress, get some exercise each day, get natural light, avoid excessive artificial light, and get plenty of sleep each night.  Living a healthy lifestyle might completely attenuate your headaches.
  3. Dosage adjustment: If your headaches have become an annoying Zoloft side effect, you may want to ask your psychiatrist about dosage adjustments. Sometimes decreasing your Zoloft dosage or titrating down to the “minimal effective dose” might alleviate your headaches.  In other cases, you might need to increase your dose to better treat conditions like anxiety and/or depression – each of which might be responsible for causing your headaches.
  4. Concurrent medications: If you’re using other substances (medications and/or supplements) along with Zoloft, it is recommended that you review them with your doctor. Concurrent substance use might be the chief reason that you’re experiencing headaches.  If a substance that you’re using is interacting with Zoloft, this interaction effect might be the reason you’re experiencing headaches.  Another possibility is that concurrently administered substances are causing headaches as a side effect – and you’ve mistakenly blamed the headaches on Zoloft.  For this reason, you may want to discontinue all medically-unnecessary substances for a while and see if your headaches abate.  Another option might be to add another medication or supplement to your daily regimen to prevent and/or treat headaches.
  5. Use for a longer-term: If you’re a new Zoloft user and are experiencing headaches, you may want to try using it for a longer-term. Sometimes headaches are merely a transient side effect due to lack of physiologic adjustment to Zoloft.  If the headaches you’re experiencing are a side effect stemming from lack of physiologic adaptation to the medication, the headaches may dissipate within 4 to 8 weeks of treatment.

Note: If you find it difficult to cope with headaches while using Zoloft, you may want to ask your doctor about Zoloft withdrawal and/or switching to another antidepressant medication.  Understand that, if you decide to discontinue Zoloft treatment, headaches may worsen or persist for a while until your neurochemistry rebalances.

Conclusion: Does Zoloft cause headaches or treat headaches?

As was mentioned earlier, Zoloft may cause headaches in a subset of users and prevent or reduce the frequency and/or severity of headaches in others.  Individual variables will determine who is most at risk of experiencing Zoloft-induced headaches.

If you’ve used Zoloft for a reasonable length of time, share a comment below mentioning whether you’ve experience headaches as a side effect of treatment.  Included below is a list of questions that you may want to answer to help others understand your experience with headaches while using Zoloft.

  • If you’ve noticed more headaches or severe headaches while using Zoloft, do you believe the headaches are directly caused by Zoloft? (Or is it possible that your lifestyle and/or concurrent substance use (medications or supplements) might be triggering your headaches?)
  • Assuming you experience headaches while using Zoloft, are they severe enough to warrant withdrawal or switching to another medication?
  • If you have a medical history of headaches, have you noticed a reduction in headache frequency or severity since initiating treatment with Zoloft?
  • Moreover, document the type of headaches that you usually experience such as: migraine, chronic tension-type headaches, etc.
  • To help others get a better understanding of your situation, mention things like your: Zoloft dosage, primary reason for using Zoloft (e.g. to treat depression), and how long you’ve used it (in total).

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{ 1 comment… add one }
  • Bebe February 11, 2018, 9:53 pm

    Zoloft (and all serotoninergic drugs) can cause bruxism (tooth grinding) and other movement disorders (dystonias, etc) through interference of dopamine signaling and decreasing dopamine. The bruxism usually occurs at night, so people might wake with terrible jaw, head, and neck pain, not realizing that they’ve been grinding their teeth during sleep. Zoloft caused SEVERE bruxism, cervical dystonia, and headaches to the point of disabling me. These effects are often irreversible or “tardive”, appearing after cessation of the drug.

    I hope you’ll include this as part of your headache article.

    One of many citations:

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