Can Amitriptyline Help Prevent Migraine?

Curated by Claudia Shannon / Research Scientist / ishonest

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.

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This article explores what current research suggests about the risks and benefits of using amitriptyline for migraine prevention.

What is amitriptyline?

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).

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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.

How does amitriptyline work for migraine?

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.

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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.

How does amitriptyline help children with migraine?

A 2019 literature review concluded that there isn’t enough evidence to recommend amitriptyline to prevent migraine attacks in children.

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.

What is the usual dose of amitriptyline for migraine?

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.

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The maximum dose of amitriptyline is 300 mg per day, and higher doses are more likely to cause side effects.

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.

How much does amitriptyline cost?

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.

What are the side effects of taking amitriptyline for migraine?

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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

Can amitriptyline interact with other medications?

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.

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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.

How effective is amitriptyline?

Research shows that low doses of amitriptyline can be an effective treatment for preventing migraine attacks.

A more recent 2019 literature review concluded that among antidepressants commonly prescribed to prevent migraine attacks, amitriptyline has the most evidence of being effective.

The takeaway

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.

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