From the Guidelines
Elavil (amitriptyline) is an effective medication for preventing migraines, with a recommended starting dose of 10-25 mg taken once daily at bedtime, which can be gradually increased to 50-100 mg daily if needed and tolerated, as supported by studies such as 1 and 1.
Key Points to Consider
- The dosages that were most efficacious in the clinical trials ranged from 30 to 150 mg/d, as noted in 1.
- Amitriptyline works by regulating serotonin and norepinephrine levels in the brain, which helps stabilize pain pathways involved in migraine development.
- Common side effects include drowsiness, dry mouth, constipation, and weight gain, as reported in 1 and 1.
- The sedative effect is why it's typically taken at night.
- Patients should be aware that full benefits may take 4-6 weeks to develop, and the medication should not be stopped abruptly.
- Amitriptyline is contraindicated in patients with certain heart conditions or those taking MAO inhibitors, as cautioned in 1 and 1.
- It's essential to discuss all current medications with your doctor before starting treatment to avoid potential interactions, as advised in 1 and 1.
Recent Guidelines
- The 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache, referenced as 1, provides updated recommendations for migraine prevention and treatment.
- While amitriptyline is not listed as a first-line recommendation in the latest guideline, it is still considered an effective option for migraine prevention, as supported by older studies such as 1 and 1.
Patient Education
- Patients should be educated about the control of acute attacks and preventive therapy and engaged in the formulation of a management plan, as emphasized in 1 and 1.
- Therapy should be reevaluated on a regular basis to ensure optimal treatment outcomes.
From the Research
Treatment of Migraine with Elavil
- Elavil, also known as amitriptyline, is a medication used in the prophylactic treatment of migraine 2, 3, 4, 5, 6.
- The choice of prophylactic drugs, including amitriptyline, depends on efficacy, co-morbidity, side effects, availability, and cost 2.
- Amitriptyline has been shown to be effective in reducing the frequency and severity of migraine attacks 3, 5.
- A study comparing the efficiency of amitriptyline, fluoxetine, and maprotiline in preventing migraine attacks found that amitriptyline was the most effective, with 71% of patients experiencing a reduction in migraine frequency 3.
- Another study found that amitriptyline was superior to placebo in migraine prophylaxis at 8 weeks, but the difference was not significant at subsequent time points due to a robust placebo response 5.
- Amitriptyline has also been shown to be effective in the treatment of chronic daily headache (CDH), with a significant improvement in headache frequency compared to placebo 5.
- The optimal dose of amitriptyline for migraine treatment is not established, but low doses (10-25 mg daily) have been found to be effective and well-tolerated in some studies 6.
- Common side effects of amitriptyline include daytime fatigue, and the medication can be effective in patients with comorbid insomnia 4, 6.
- Further research is needed to fully understand the efficacy and tolerability of amitriptyline as a migraine preventive 4.