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amitriptyline in the treatment of migraine

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Although amitriptyline is not licensed for the prophylactic treatment of migraine.

Amitriptyline 10-150mg daily, at or 1-2 hours before bedtime, is first-line prophylaxis when migraine coexists with (1):

  • troublesome tension-type headache
  • another chronic pain condition
  • disturbed sleep
  • depression - note that except in the case of depression, it is wise to explain the choice of this drug to patients who do not consider themselves depressed or they may reject it

Amitryptiline may prevent migraine by blocking 5-HT2 receptors on cerebral vessels and central neurones.

The usual initial dose is 10mg and this dose is increased in a step-wise manner (usually every two to four weeks) by 10mg per day.

Check the respective summary of product characteristics before prescribing this drug.

Reference:

  1. British Association for the Study of Headache (BASH) guidelines, 2004.
  2. Prescriber's Journal 1993; 33: 56.
  3. Wood, A.J.J.. Drug therapy of migraine. NEJM 1993; 329 (20): 1476-1484.

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