Can Straterra (atomoxetine) be used to treat headaches and sleepiness?

Strattera (Atomoxetine) Is Not Indicated for Treating Headaches or Sleepiness

Strattera (atomoxetine) is not recommended for treating headaches or sleepiness and may actually worsen these symptoms as side effects of the medication. Atomoxetine is specifically indicated for attention-deficit/hyperactivity disorder (ADHD) and has been associated with increased risk of headaches as a common adverse effect 1.

Headaches and Atomoxetine

Evidence Against Using Atomoxetine for Headaches

• Atomoxetine is associated with an increased risk of headaches compared to placebo (OR = 1.29,95% CI = 1.06-1.56) 1
• Headache is listed as one of the most common adverse reactions to atomoxetine 2
• Clinical guidelines do not recommend atomoxetine for headache treatment 3

Recommended Headache Treatments

For migraine and headache treatment, guidelines recommend:

1. First-line treatments for mild to moderate headaches:

   • NSAIDs (ibuprofen 400-800mg every 6 hours)
   • Acetaminophen (650-1000mg every 4-6 hours) 3

2. For moderate to severe headaches:

   • Triptans (sumatriptan 50mg orally)
   • Combination therapy (triptan + NSAID) 3

Sleepiness and Atomoxetine

Evidence on Atomoxetine and Sleep

• While atomoxetine appears to be "sleep neutral" compared to stimulants 4, it is not indicated for treating sleepiness
• Atomoxetine has been shown to cause somnolence in some patients 2
• For excessive daytime sleepiness, guidelines recommend modafinil as first-line treatment, not atomoxetine 5

Recommended Treatments for Excessive Sleepiness

For patients with excessive daytime sleepiness, guidelines recommend:

1. First-line pharmacological treatment:

   • Modafinil (starting at 100mg once upon awakening) 5

2. Other options:

   • Sodium oxybate
   • Traditional stimulants (methylphenidate, amphetamines)
   • Behavioral modifications (scheduled naps, regular sleep schedule) 5

Important Clinical Considerations

Atomoxetine's Proper Use

• Atomoxetine is specifically indicated for ADHD in children and adults 5, 2
• Typical dosing starts at 40mg daily and can be titrated up to 80-100mg daily 5
• It works by selectively inhibiting presynaptic norepinephrine reuptake 2

Monitoring for Adverse Effects

• When using atomoxetine for its approved indication (ADHD), monitor for:
  • Headaches (common side effect)
  • Somnolence
  • Decreased appetite
  • Abdominal pain
  • Nausea 2

Clinical Pitfalls to Avoid

1. Do not use atomoxetine to treat headaches - this may worsen the condition as headache is a known side effect 1

2. Do not use atomoxetine as a sleep aid or to treat sleepiness - it is not indicated for this purpose and may cause somnolence in some patients while not addressing the underlying cause of sleepiness 2

3. Avoid medication overuse - using any acute headache medication too frequently (>2 times/week) can lead to medication overuse headache 3

4. Consider proper diagnosis - both headache and sleepiness could be symptoms of various conditions requiring specific treatment approaches rather than symptom management with inappropriate medications

If a patient is experiencing both ADHD symptoms and headaches or sleepiness, the appropriate approach would be to treat the ADHD with atomoxetine if indicated, while separately addressing the headache or sleepiness with evidence-based treatments specific to those conditions.