From the Guidelines
Amitriptyline is recommended for chronic migraine prevention at a starting dose of 30-150 mg/d, as indicated by the studies 1. The dosages that were most efficacious in the clinical trials ranged from 30 to 150 mg/d, with amitriptyline being the only antidepressant with consistent support for efficacy in migraine prevention 1. Some key points to consider when using amitriptyline for chronic migraine prevention include:
- Starting with a low dose and gradually increasing as tolerated until reaching an effective dose
- Taking amitriptyline at night due to its sedating effects
- Being aware that full benefits may take 4-6 weeks to develop
- Common side effects include dry mouth, constipation, drowsiness, and weight gain
- Amitriptyline works by increasing levels of serotonin and norepinephrine in the brain, which helps regulate pain pathways involved in migraine development
- It's particularly effective for patients who experience migraines with comorbid depression, anxiety, or sleep disturbances, as it addresses these conditions simultaneously
- Regular follow-up with a healthcare provider is essential to monitor effectiveness and manage any side effects. The evidence suggests that amitriptyline is a effective option for chronic migraine prevention, and its use should be considered in patients who meet the criteria for preventive therapy, as outlined in the studies 1.
From the Research
Recommended Treatment for Preventing Chronic Migraines with Amitriptyline
- Amitriptyline is a tricyclic antidepressant that has been shown to be effective in preventing chronic migraines 2, 3, 4, 5, 6.
- The recommended dose of amitriptyline for preventing chronic migraines is typically started at a low dose and increased slowly until therapeutic benefit is achieved or side effects preclude continued use 2.
- Studies have shown that amitriptyline is superior to placebo in reducing headache frequency in patients with chronic daily headache (CDH) and intermittent migraine (IM) 4.
- Amitriptyline has been found to be effective in reducing headache frequency by at least 50% in a significant number of patients with CDH and IM 4.
- The use of amitriptyline for migraine prevention is supported by evidence-based guidelines from the American Academy of Neurology (AAN) and the Canadian Headache Society (CHS) 6.
Key Considerations for Using Amitriptyline
- The choice of amitriptyline as a preventive treatment for migraines should be based on patient preferences, comorbidities, and the presence of other illnesses 2, 3, 6.
- Patients should be counseled about the potential side effects of amitriptyline, including sedation, dry mouth, and weight gain 5.
- The sedating effect of amitriptyline can be beneficial for patients with comorbid insomnia 5.
- Alternative treatments, such as nortriptyline, venlafaxine, and duloxetine, may be considered in patients who do not tolerate amitriptyline or have comorbid depression 5.