Can Amitriptyline and Sumatriptan Be Taken Together for Migraines?
Yes, amitriptyline and sumatriptan can be safely taken together for migraine management, as they work through different mechanisms and serve complementary purposes in migraine treatment. 1
Mechanism and Role of Each Medication
Amitriptyline
- Purpose: Preventive therapy for migraines
- Dosage: 30-150 mg per day 1
- Mechanism: Tricyclic antidepressant that helps prevent migraine attacks
- Evidence: Consistently supported as effective for migraine prevention 1
Sumatriptan (Imitrex)
- Purpose: Acute treatment of migraine attacks
- Mechanism: Triptan that acts as a serotonin receptor agonist to abort ongoing migraine attacks
- Evidence: Good evidence for efficacy in treating acute migraine attacks 1, 2
Complementary Treatment Approach
These medications work in different ways and for different purposes:
- Amitriptyline is taken daily to reduce the frequency and severity of migraine attacks
- Sumatriptan is taken only during an actual migraine attack to abort the headache
Important Considerations
When to Use Preventive Therapy (Amitriptyline)
Consider preventive therapy with amitriptyline when:
- Patient has two or more migraine attacks per month with disability lasting 3+ days per month
- Acute treatments have failed or are contraindicated
- Patient uses acute medications (like sumatriptan) more than twice per week
- Patient has uncommon migraine conditions (hemiplegic migraine, prolonged aura, migrainous infarction) 1
Dosing Guidelines
- Amitriptyline: Start with a low dose and gradually increase to 30-150 mg per day 1
- Sumatriptan: Use as needed for acute attacks (typically 25-100 mg orally) 2
Potential Side Effects
- Amitriptyline: Drowsiness, weight gain, anticholinergic symptoms 1
- Sumatriptan: Transient sensations of warmth, tingling, chest/neck tightness 2
Cautions and Contraindications
Risk of Medication Overuse Headache
- Limit use of sumatriptan to no more than twice per week to avoid medication-overuse headaches 1
- If sumatriptan is needed more frequently, this indicates a need to optimize the preventive therapy (amitriptyline)
Contraindications for Triptans
Do not use sumatriptan in patients with:
- Uncontrolled hypertension
- Basilar or hemiplegic migraine
- Risk factors for heart disease 1
Monitoring and Follow-up
- Use a headache diary to track:
- Frequency, severity, and duration of attacks
- Response to both preventive and acute treatments
- Any adverse effects
- Allow 2-3 months to evaluate the full effectiveness of amitriptyline 1
- Consider tapering or discontinuing amitriptyline after a period of stability 1
This combined approach of using amitriptyline for prevention and sumatriptan for acute treatment represents a comprehensive strategy for managing migraines, addressing both prevention and treatment of acute attacks.