Dosulepin (Prothiaden) for Headache Treatment
Prothiaden (dosulepin) is not recommended for headache treatment as it is not indicated for this condition and does not appear in any headache treatment guidelines. 1
Appropriate Medications for Headache Treatment
For Migraine Headaches:
First-line treatments for acute migraine attacks include:
For migraine prevention when indicated (≥2 attacks/month with significant disability):
- Beta-blockers: propranolol (80-240mg/day) or timolol (20-30mg/day) have consistent evidence of efficacy 1, 2
- Amitriptyline: 25-50mg daily (range 10-150mg) is the only antidepressant with consistent evidence for migraine prevention 3, 1
- Anticonvulsants: divalproex sodium and sodium valproate have good evidence of efficacy 1, 2
Adjunctive Treatments:
- Metoclopramide (10mg) or prochlorperazine (25mg) can be used to treat associated nausea and improve gastric motility during migraine attacks 1
- Combination medications like isometheptene/acetaminophen/dichloralphenazone (Midrin) may be effective for milder migraine headaches 1
Why Dosulepin Is Not Appropriate for Headache Treatment
- Dosulepin (Prothiaden) is a tricyclic antidepressant primarily indicated for depression, not headache 4, 5
- The FDA label for dosulepin does not mention headache as an indication 4
- Current migraine treatment guidelines do not include dosulepin in their recommendations 1
- Among tricyclic antidepressants, only amitriptyline has consistent evidence supporting efficacy in migraine prevention 1, 3
Dosulepin Information (For Depression, Not Headache)
- Standard dosing for depression: 75-150mg/day with a maximum of 300mg/day 4, 5
- Can be administered as a single daily dose, typically at bedtime 4, 6
- Side effects include dry mouth, drowsiness, and potential cardiovascular effects 5, 7
Clinical Recommendations for Headache Management
- For acute migraine treatment: Use NSAIDs or triptans based on headache severity and previous response 1
- For migraine prevention: Consider evidence-based options like propranolol, amitriptyline, or divalproex sodium 1, 3, 2
- For tension-type headaches: NSAIDs are typically first-line treatment 1, 8
- For mixed headache types: Amitriptyline may be particularly effective 1, 3
Important Clinical Pitfalls
- Avoid using medications without evidence for headache treatment, as this may delay effective therapy 1
- Be cautious about medication overuse headache when acute medications are used more than 2-3 days per week 1, 9
- Preventive therapy should be considered when patients have ≥2 attacks per month with significant disability or use acute medications more than twice weekly 1, 9
- Adequate trials of preventive medications require 2-3 months to assess efficacy 3, 2