This is an open label pilot study to determine whether milnacipran can reduce headache frequency in episodic and chronic migraine sufferers.

Patients with episodic migraine with and/or without aura and chronic migraine will be treated with 100 or 200 mg of milnacipran for a total of 4 months including a one month titration phase and a 3 month maintenance phase. Baseline (pre-treatment) and end-of-maintenance phase headache frequencies will be recorded. There is no placebo treatment in this study. In addition to headache frequencies, other parameters being measured include safety and tolerability.

Inclusion Criteria:

• Migraine with or without aura or chronic migraine.
• Subject age 18 to 70.
• At least 2 migraine attacks per month.
• Willing ang able to give written informed consent.
• Willing and able to complete the entire course of the study and to comply with study instructions.
• Willing to taper and discontinue their current preventive medications.

Exclusion Criteria:

• Subject is pregnant, lactating or planning a pregnancy in the next year.
• Subject is female of child-bearing potential and not taking adequate forms of birth control.
• Significant medical or psychiatric disease or abnormal laboratory data that would preclude entry into this study.
• Previous failure of four or more adequate trials of preventive medication.
• Currently on any form of antidepressant for depression and not able to discontinue.
• Currently demonstrating medication overuse headache.
• Currently has uncontrolled narrow angle glaucoma.
• Currently taking monoamine oxidase inhibitors.
• Subject has a history of seizures.
• Participation in an investigational drug study within the last 30 days or 5 half-lives, whichever is longer.