Amitriptyline is a prescription tricyclic antidepressant (TCA). Amitriptyline is sometimes prescribed off-label at low doses to prevent migraine attacks.
But does it work? Evidence suggests that it does work for some people. However, like any medication, it comes with a chance of side effects.
This article explores what current research suggests about the risks and benefits of using amitriptyline for migraine prevention.
Amitriptyline is part of a class of drugs called tricyclic antidepressants (TCAs). TCAs are typically prescribed for depression, but many have additional uses.
It was approved by the Food and Drug Administration (FDA) to treat depression in 1977 and sold under the brand name Elavil. Although Elavil was discontinued in 2000, amitriptyline is still available in generic forms.
Amitriptyline in particular has been used to treat a wide range of conditions that cause chronic pain, including migraine. It’s typically used for migraine prophylaxis (prevention).
Using amitriptyline to prevent migraine attacks isn’t new, with research dating back to the 1970s. For instance, a
Other countries have formally approved the use of amitriptyline for migraine prevention. In the United Kingdom, the Medicines and Healthcare Products Regulatory Agency (MHRA) lists the prophylactic treatment of migraine in adults as one of amitriptyline’s therapeutic uses.
Amitriptyline increases the effects of the neurotransmitter serotonin in the brain. Serotonin is associated with emotional well-being, pain regulation, and other biological functions such as sleeping and eating.
There’s no single explanation for why migraine attacks occur. They’re caused by a combination of contributing factors.
For some people, serotonin is one of those factors. Research has shown that people who experience migraine attacks are more likely to have low levels of serotonin. For many, alterations in serotonin level or activity can trigger a migraine attack.
Amitriptyline’s effect on migraine might be related to its effect on serotonin levels. More research needs to be done to understand its exact mechanism of action.
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However, the review also reported that children between 10 and 17 who were treated with amitriptyline alongside cognitive behavioral therapy (CBT) were more likely to experience a reduction in chronic headaches.
The recommended starting dose of amitriptyline for migraine is 10 milligrams (mg) per day. If you aren’t getting adequate migraine prevention and aren’t having intolerable side effects, your doctor might increase your dose by up to 25 mg per week.
The maximum dose of amitriptyline is
Amitriptyline is available in tablet and liquid form. Since amitriptyline can make you feel drowsy, it’s best to take it at night before you go to sleep.
The cost of amitriptyline varies according to where you live and how much you buy.
According to ClinCalc.com, the average cost of amitriptyline in 2018 was $24.65 per prescription fill. In addition, the average prescription lasted approximately 44 days.
Like any medication, amitriptyline can cause side effects. The most common side effects are mild, and include:
- constipation
- difficulty urinating
- dizziness
- drowsiness
- dry mouth
- headaches
- sweating
- weight gain
Although serious side effects are less common, they can occur. You should seek medical attention right away if you experience any of the following while taking amitriptyline:
- changes in eyesight
- confusion
- eye pain or swelling
- manic thoughts or behavior
- muscle cramps
- racing heartbeat
- seizures
- stroke
- suicidal thoughts
- yellow skin
Amitriptyline may cause headaches
Headaches (but not migraine attacks) are a
Amitriptyline can interact with other drugs, increasing your risk for side effects.
In particular, amitriptyline can interact with opioid painkillers such as codeine, oxycodone, or morphine. The combination can increase your risk for drowsiness and breathing difficulties.
Amitriptyline can also interact with another type of antidepressant called monoamine oxidase inhibitors (MAOIs), triggering dangerously high blood pressure. This can occur even after you’ve stopped taking MAOIs.
Before taking amitriptyline, talk with your doctor or pharmacist about substances you’ve taken or are currently taking, including herbal remedies, vitamins, and supplements.
Warnings
The FDA adds a
Amitriptyline has a box warning for suicidal thoughts and behaviors in children and young adults. Adults who have major depressive disorder (MDD) are also at an increased risk for suicidal thoughts and behaviors while taking amitriptyline.
The FDA warns that amitriptyline carries a risk of acute angle closure glaucoma, a potentially serious condition that causes increased pressure in the eye.
Finally, amitriptyline can pose additional risks to pregnant and nursing people.
Research shows that low doses of amitriptyline can be an effective treatment for preventing migraine attacks.
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Similarly, a
A more recent
Your doctor might prescribe amitriptyline to prevent migraine headaches. Although amitriptyline hasn’t been approved by the FDA for migraine prophylaxis (prevention), research suggests that it’s effective at low doses.
If you think amitriptyline might be able to help with your migraine episodes, talk with your doctor about your symptoms. Your doctor can help you weigh the risks and benefits of taking amitriptyline.