From the FDA Drug Label
- Dosage and Administration Oral Dosage Dosage should be initiated at a low level and increased gradually, noting carefully the clinical response and any evidence of intolerance. Initial Dosage for Adults For outpatients, 75 mg of amitriptyline HCl a day in divided doses is usually satisfactory. If necessary, this may be increased to a total of 150 mg per day Increases are made preferably in the late afternoon and/or bedtime doses.
The FDA drug label does not answer the question.
From the Research
Amitriptyline is recommended for post-concussive headache at a starting dose of 10-25 mg taken orally at bedtime, which may be gradually increased to 25-50 mg nightly if needed and tolerated. This recommendation is based on the most recent and highest quality study available, which suggests that low doses of amitriptyline are effective and well-tolerated in the treatment of chronic headache disorders 1. The medication should be started at a low dose and increased slowly over several weeks to minimize side effects like drowsiness, dry mouth, and constipation. Amitriptyline works by affecting neurotransmitters in the brain that regulate pain perception and can help prevent headaches rather than treat them once they occur. It typically takes 2-4 weeks to see the full benefit. Patients should take this medication consistently every night, not just when headaches occur. If side effects are problematic, taking the dose earlier in the evening (3-4 hours before bedtime) may help. Patients should discuss with their healthcare provider before stopping the medication, as it typically requires gradual tapering. Amitriptyline should be used cautiously in elderly patients and those with certain medical conditions like heart problems or glaucoma.
Some key points to consider when prescribing amitriptyline for post-concussive headache include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for side effects and adjusting the dose or timing of administration as needed
- Encouraging patients to take the medication consistently every night, rather than just when headaches occur
- Gradually tapering the medication when stopping treatment to minimize withdrawal symptoms
- Using caution in elderly patients and those with certain medical conditions, such as heart problems or glaucoma
Overall, the use of amitriptyline for post-concussive headache is supported by the available evidence, and it is considered a safe and effective treatment option when used appropriately 2. However, it is essential to carefully consider the individual patient's needs and medical history when prescribing this medication.