Migraine treated with amitriptyline

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

Amitriptyline 10-150mg daily, at or 1-2 hours before bedtime (1):

• starting dose 10mg per day
• titration 10-25 mg
• maximum dose 150mg per day
• preventative medications must be titrated slowly to an effective or maximum tolerable dose and continued for at least 6-8 weeks to adequately assess effect
• consider gradual withdrawal after 6-12 months of effective prophylaxis

Previous BASH guidance noted that amitriptyline may be a useful prophylaxis if migraine coexists with (2):

• 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, 2019.
2. British Association for the Study of Headache (BASH) guidelines, 2004.