Amitriptyline in migraine prophylaxis: Changes in pattern of attacks during a controlled clinical trial

Abstract

SUMMARY A double-blind controlled clinical trial of crossover design was conducted in 26 volunteers suffering from migraine. Of 20 subjects who completed the trial, 16 had fewer attacks on amitriptyline than on placebo. Amitriptyline was found to have the greatest effect in reducing attacks with a short warning and in which no specific cause could be recognized. It had least effect in attacks with a long warning and recognized as due to fatigue. The drug was effective only in reducing those attacks with shorter duration and its effect was irrespective of severity. A dosage of between 10 and 60 mg, usually taken at night, was found to be adequate.Amitriptyline has been found effective in chronic tension headache (Lance and Curran, 1964) and its beneficial use in migraine has been reported (Friedman, 1968;Mahloudji, 1969).Although its precise mode of action in migraine is uncertain, amitriptyline and the tricyclic antidepressants possess similarities in structure and pharmacological effect to some of the recently introduced prophylactic agents used in this condition. SELECTION OF SUBJECTSVolunteers were requested via the British Migraine Association and the press. The criteria of migraine used was the presence of intermittent headache with at least three of the following features: unilateral distribution, sensory prodromata, associated nausea; photophobia and throbbing.All subjects were asked to keep a record of their migraine attacks. These showed the information listed in Table 1. The charts were returned and discussed every two months with a statement as to their accuracy. It was indicated that attacks causing no disturbance of daily routine should be recorded as mild; those causing some lack of efficiency as moderate, and those causing complete disruption of usual activities should be recorded as severe.Of 114 volunteers, 94 were excluded as follows. Seventy-five were excluded before or during a 26 week control period. Only those subjects having more than two attacks per month and with over 50% described as at least of moderate severity were

Amitriptyline and aerobic exercise or amitriptyline alone in the treatment of chronic migraine: a randomized comparative study

“…In addition to reducing the frequency, duration and intensity of headache attacks, therapy with amitriptyline may improve the response to acute treatment, reduce disability, and reduce associated economic costs 7,8 . The use of amitriptyline for treatment of migraine resulted in 50% reduction in the headache frequency.…”

“…Studies with amitriptyline demonstrate limited evidence that the treatment may be beneficial for patients with chronic migraine 14 . Although several studies addressing prophylactic treatment for episodic migraine 6,7,8,9,10,11,12,13,14 , only topiramate 15 and the botulinum toxin 16 were effective in placebo-controlled studies for the prophylactic treatment of patients with chronic migraine.…”

Cognitive therapy vs. self‐management training in the treatment of chronic headaches

“…A large study by Lance & Curran (1964) demonstrated that an antidepressant (amitriptyline) was the drug of choice for tension headaches, and other studies have shown its value as a prophylactic agent for migraine (Couch et a/., 1976;Gommersal & Stuart, 1973). However, the findings of Lance & Curran implied that antidepressants alleviated headaches independently of their antidepressant action.…”

Evaluation of the Prophylactic Efficacy of Amitriptyline and Citalopram, Alone or in Combination, in Patients with Comorbidity of Depression, Migraine, and Tension-Type Headache

“…Although few studies [17,18] have provided evidence for a high efficacy of amitriptyline in migraine, this classical tricyclic antidepressant seems to be effective in the prophylaxis of both migraine and chronic TTH [19][20][21][22][23][24][25].…”