Amitriptyline for Migraine Prevention

What You May Experience From Taking Amitriptyline for Preventing Migraines

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Amitriptyline (Elavil), a tricyclic antidepressant, is commonly used in the prevention of migraines. Let's learn more about this medication, including its possible side effects.

Is Amitriptyline Effective in Preventing Migraines?

It appears that amitriptyline is effective, although there are few scientific studies that have compared amitriptyline with a placebo. One 2011 study in Headache, found that amitriptyline was effective in preventing migraines when compared to placebo at 8 weeks of use, but not up to 20 weeks.

In another 2009 study in Clinical Therapeutics, both Topamax and amitriptyline were found to be similar and effective in preventing episodic migraines. Topamax is FDA-approved as a migraine prevention medication whereas amitriptyline is not — it's used off-label. 

What is the Downside of Amitriptyline in Preventing Migraines?

The downside is that amitriptyline does cause some side effects that sometimes cause people to discontinue it. These may include: dry mouth, fatigue, somnolence, weight gain, dizziness, constipation, sinusitis, and orthostatic hypotension — a drop in blood pressure when a person moves from a laying or sitting position to a standing position. 

Amitriptyline may also increase a person's risk of bone fractures, and cause a decrease in the number of blood cells, although this is rare. 

Amitriptyline can also interact with a number of medications — so be sure to inform your doctor of all medications, over-the-counter supplements, and vitamins.

In addition, please inform your doctor of your entire medical history. Amitriptyline should be avoided or used in caution in people with a history of heart disease, heart or rhythm abnormalities, diabetes, liver or kidney impairment, bipolar disorder, seizure disorder, narrow-angle glaucoma, dry eyes or vision problems, decreased gastrointestinal motility, urinary retention or an enlarged prostate.

Finally, like other antidepressants, amitriptyline can increase suicidal thoughts or behavior. Be sure to contact your physician right away if any side effects, even ones not mentioned, are bothersome or persistent. Call 911 in the case of an emergency. 

Other Precautions with Amitriptyline:

  • It is very important that your doctor check your progress at regular visits to allow dosage adjustments and to help reduce side effects.
  • This medicine will add to the effects of alcohol and other CNS depressants.
  • This medicine may cause drowsiness. If this occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert.
  • Tricyclic antidepressants may cause your skin to be more sensitive to sunlight.
  • Do not stop taking this medicine without first checking with your doctor.
  • The effects of this medicine may last for 3 to 7 days after you have stopped taking it.

What Does This Mean for Me?

Amitriptyline is an effective  migraine preventive medication for many people. That being said, it's also wise to be knowledgeable of its potential side effects, as with all medications. This way you can feel assured you are taking it safely. As always, be sure to discuss all concerns and questions with your physician.

Disclaimer: Material on this page is for informational purposes only, and should not be construed as medical advice. Always consult your physician regarding medications.

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Article Sources
  • Couch JR & Amitriptyline Versus Placebo Study Group. Headache. 2011 Jan;51(1):33-51.
  • Dodick DW et al. Topiramate versus amitriptyine in migraine prevention: a 26-week, multicenter, randomized, double-blind, double-dummy, parallel-group noninferiority trial in adult migraineurs. Clin Ther. 2009 Mar;31(3):542-59.
  • Lexicomp Online. Amitriptyline. Retrieved November 25th 2015. 
  • Shamliyan TA et al. Preventive pharmacologic treatments for episodic migraine in adults. J Gen Intern Med. 2013 Sep;28(9):125-37.