Amitriptyline has been in use for over 50 years. Initially, it was used to treat depression at relatively high doses. Presently, it is used mostly for nerve pain, migraine, tension headache and irritable bowel syndrome. The aim of treatment is to reduce the severity and number of headache days per month. Like most migraine treatments, it will not cure the migraine, or get rid of them completely.
How should I take amitriptyline?
It is usually started at a low dose of 10mg at night, increasing by 10 mg every week up to a target dose of 100 mg (or highest tolerated dose below this). This medication should be taken approximately 2 hours before you go to sleep- if taken too late, you may be drowsy in the morning.
For how long should I take amitriptyline?
Amitriptyline should be taken for 3 months before judging the effectiveness. You should keep a headache diary to record the total number of headache days and severe headache days to track progress. If effective, continue for 9-12 months before starting to reduce slowly, aiming to stop. Sometimes, after controlling migraine effectively for 6-12 months, the medication can be withdrawn. As this isn’t a cure, it might need to be restarted if the headaches become frequent again.
It is important that you do NOT stop this medication abruptly – it needs to be reduced slowly to prevent withdrawal symptoms.
Common potential side effects include (not everyone experiences these)
- Dry mouth
- Constipation
- Drowsiness
- Weight gain
- Blurry vision
What happens if I experience side effects?
Individuals experience different effects and side effects from the drug. Many side effects, including drowsiness, ease after taking it for a few weeks at a stable dose. Avoid driving or operating heavy machinery if this makes you too drowsy (if you work, it might be best to increase the dose the night before your days off so that any drowsiness won’t affect your work or ability to travel to work).
If side effects are too troublesome, please reduce the dose a little to one that is tolerated better. Reducing by 10 mg is fine to do without asking your GP, if you have the correct sized tablets allowing that (they come in 10 mg, 25 mg and 50 mg tablets). If side effects become extremely troublesome, or you are uncertain about whether the side effects are due to the drug, please speak to your headache specialist or GP.
Amitriptyline is generally avoided in patients with:
- A pre-existing heart condition
- Severe depression
- Epilepsy
- Glaucoma
- Chronic constipation
- Liver disease
- Allergy to amitriptyline or related medications
If you are taking other medication to treat depression, amitriptyline can have more pronounced cognitive side effects (e.g. drowsiness, difficulty thinking) and can cause low salt (sodium) levels.
More information can be found at:
Date of Review: November 2023
Date of Next Review: November 2025
Ref No: PI_M_778 (Salford)