Can tricyclic antidepressants help prevent migraine headaches?

Donna Hill Howes, RN
Family Practitioner

The tricyclic antidepressants amitriptyline and nortriptyline (Pamelor) are 2 of the most effective drugs for preventing migraines. These drugs have been used and studied as a preventive treatment for migraines, but they are not FDA-approved for this use. 

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Tricyclic antidepressants, such as amitriptyline, are used successfully by some individuals for preventive treatment of migraine attacks.

These medications are proved to reduce headache severity, frequency, and duration; they are often prescribed for chronic tension-type headaches.

Be aware that possible side effects include increased appetite and weight gain. People who have abnormal heart rhythms should not use tricyclic antidepressants.

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Tricyclic antidepressants are sometimes prescribed to treat various types of pain, including headache. Amitriptyline (Elavil, Endep) is the best studied for pain relief and the most often prescribed for migraine prevention: it's about 60% effective in thwarting such headaches. Other tricyclics used in migraine prevention include doxepin (Adapin, Sinequan), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor). It is not clear how the tricyclics work, but it is possible that they relieve pain by increasing the availability of the neurotransmitters serotonin and norepinephrine, which not only affect mood but also act to reduce the transmission of pain signals in the brain.

When taking a tricyclic, you probably won't notice any benefit in the first week or two, and you may not feel its full effects for several weeks. However, some sedative effects are common early in treatment, which is a bonus for the many people with migraine who also have difficulty sleeping. Although a tricyclic could potentially improve mood, the doses prescribed for headache prevention are much lower than those used in treating depression.

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