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Amitriptyline for Chronic Daily Headache+ Migraines?

Hi everyone,
I have had a continuous headache and at least 8 migraine attacks for the past three weeks. They feel more like spasms shooting up from the back of my head, sometimes pulsates, sometimes jabs, sometimes involve eye pain, and alternates between both sides of my head. I am waiting for an appointment to see a neurologist so in the meantime I just keep going to my family doctor. I had a CT scan without contrast at the hospital, showed nothing, so they gave me IV of a muscle relaxant + anti-nauseant and sent me home.

Tried so far: tramacet (tramadol+tylenol), naproxen, advil, tylenol, tylenol + codeine+ caffeine and imitrex. Nothing has worked.

So my doc prescribed Amitriptyline (elavil). I started at 10mg for 7 days and I am now taking 20mg and it is day 10. Headache pain still here (some spasms throughout the day). The drowsiness and dry mouth side effect I can handle but it seems to have increased my heart rate and increased my anxiety (leading to a few panic attacks) as well.

My question is: has anyone tried Amitriptyline and it worked? how long does it take to work and at what dosage? I am just concerned that the anxiety is being caused by Amit. and I don't want to keep taking it if it does not work. Also if I keep taking it, and it does not work, then I will have to deal with the withdrawal symptoms. Please help, I need advise. :(
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Avatar universal
The drug you take is one of the most used and well known headache drugs in use. It is usually very effective.

For unknown reasons it takes a minimum of two weeks before it starts to work. Usually a bit longer. The dosage is increased slowly and it is only when you reach your individual target level that it will start to work for you. You don't know this level before hand. Then after a while the effect goes down typically, as the body adjusts to the drug, and you will have to up the dosage once again to find your new effective level. But the drug is known to work on a broad spectrum of headaches and it is usually very effective.

It is not without side effects though. Weight gain and dry mouth are some of the common side effects. Beta blockers like propranolol are other examples of very effective headache drugs. But they are considered to be more migraine specific. Amitriptyline is usually given when the doc is not sure what is the root of your headache. On the other hand, almost all headaches are migraine headaches even though they might not look like it, so propranolol is probably equally efficient anyway.

Not all drugs work for all people so it is good that different alternatives exist. Usually you can discuss the side effect profiles of the different drugs with your doctor to choose the one you think might be the least uncomfortable for you.

Now that you started with amitriptyline I think you should give it a chance. Chances are it will help you:). But if you are worried about side effects you need to discuss it with your doc. Amitriptyline usually also helps with anxiety, not causes it. But everything is possible and people react differently to drugs.

Good luck!
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Avatar universal
Some of this sounds similar to my headache problems. I was initially diagnosed with sinusitis which was confirmed with CT scans and successfully operated. But the headaches remained. After more GP visit I was put on Amitriptyline and referred to a neuro doc, who diagnosed 'chronic migrainous headaches' or 'facial migraines' or something, and advised me to keep taking the Ami.

Even though the first few weeks I could tell no difference they eventually began to work, and after 3 months or so I was more or less a functioning human again.

I've been on them for the past 4 years, just tried cutting down and the headaches have started up again. I've returned my dose to 30mg but it takes a long time to be effective, 3 weeks of hell so far. But it really makes me appreciate how much ami had given me my life back and I can't wait until it's built up in my bloodstream again.
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Avatar universal
i take 150mg for migraines at night goodluck xx
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Avatar universal
I was on Elavil for years and years (til my body built up a tolerance) and it worked great....I was taking 150mg at the time I stopped taking it...HOWEVER, that was slowly increased over time. I dont know if you will find a doctor that is going to just jump in there with a big whopping dosage.
Dealing with migraines is a marathon, not a sprint. It takes time to get the right combination of medication plus dosage. You have to have patience.
P.S. I have been dealing with migraines for more than 15 yrs so, trust me, I DO know how you feel and I am not saying this lightly!!!
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Avatar universal
Have you found any relief? We are going through the same thing with my 10 year old. He is 10 days on Ami and the headaches have been daily since he started taking it. He is now on 20 mg, no relief.
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Avatar universal
Amitriptyline is one of the best meds for headache prevention there is. It is started at a low dosage and slowly increased until an effective dosage is reached. The slow increase is to minimize side effects and to give the body time to adapt. It is not possible to say when it will start to have effect since every person has a different effective dosage. Usually it is tried for at least three months. Usually it can make you feel better pretty soon but then temporarily lose its effect again as the body adapts, until the dosage is then increased again and the new effective dosage is found.

Every medication does not work on every patient. And for some patients the side effects become unbearable before the effective dosage is reached.

The first preventive drug to try is usually a beta blocker. But if the headaches are severe amitriptyline might be chosen instead. It is also believed to work on a very wide spectrum of headaches. A combination of amitriptyline and a beta blocker can sometimes have even better effect than the two drugs seperately.

Trigger identification and avoidence is of coarse equally important as a good medication.

Really terrible when a thing like this hits your young child..

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Avatar universal
Your story is so similar to ours. Our 7 year old daughter was just seen by Dr. Hershey for headaches and diagnosed with Primary Stabbing Headaches. He put her on the same amitriptylene dose regimen as your daughter but we just started the 7th day of meds and have not yet seen an effect. I am hopeful we will get there. Please email me if you'd like. I'm nearly desperate to talk to someone with this similar, rare situation.  ***@****
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Avatar universal
Your story is so similar to ours. Our 7 year old daughter was just seen by Dr. Hershey for headaches and diagnosed with Primary Stabbing Headaches. He put her on the same amitriptylene dose regimen as your daughter but we just started the 7th day of meds and have not yet seen an effect. I am hopeful we will get there. Please email me if you'd like. I'm nearly desperate to talk to someone with this similar, rare situation.  ***@****
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Avatar universal
You should NEVER take any pain reliever every day to treat headaches.  It just results in rebound headaches.  There are other daily migraine preventative medications, including an herbal one called Petadolex.  Please see my entry just above.  Headaches are very disabling.  So if the Petadolex (get online) doesn't work, you really need to try one of the other daily preventative medications. If they don't work, then your daughter would qualify for Botox injections which have been more help than anything else that I do.  They are safe in the recommended doses.
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Avatar universal
Thanks for alerting people to this herbal medication that has helped me.  One butterbur pill that does make sure that there are no impurities to cause liver damage is Petadolex. Plus herbal medications are notorious for having toxins in them since our FDA does not evaluate them.  Petadolex is manufactured in Germany where they DO evaluate their herbal medications.  So that's what I take. And yes they helped me whereas all the other daily preventative migraine pills either didn't work or caused terrible side effects.  The only thing that you need to do with the Petadolex is to take it with food.  
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Avatar universal
I did amitriptyline, with success for a year. It was the only thing that prevented the migraines. Unfortunately I gained 15 pounds and was groggy much of the time. My neurologist switched me to butter bur extract, which seems to be working, without the grogginess, and I've shed four of those pounds. And have more energy for working out and other activities. Try it, it has no side effects for me. Just make sure you get it from a high-quality manufacturer, because if it is not formulated properly, it can cause liver damage.

Good luck to you
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Avatar universal
Thank you all for your posts.  I am new to this site.  My daughter had a VERY rare bacteria in Sept '13.  She had been on 5 different meds before the stupid bacteria grew and they could treat correctly.  The one antibiotic was wicked (the pharmacist said they were only allowed to keep 2 in stock).  Long story short, she was on antibiotics for 3 months (until Dec 16). January '14 she started having headaches every day.  They did an MRI to make sure the virus hadn't come back. It was clean. Her pediatrician put on her prescription strength Aleve.  She had no relief. We waited 2 months to get an appt with the pediatric neurologist. He ordered a spinal tap to measure the pressure in her spine and it was fine.  He started her on amitriptyline (10mg). 2 weeks later no relief. Upped the dose to 20mg. Still no relief. Upped the dose to 30mg. Still no relief.  After reading all these posts, I just don't want her on this drug!! Can someone tell me what the "ginger" therapy is?  I would like to try the natural path as I feel drugs just create more issues.
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Avatar universal
If the Amitiptyline does not work, then try other daily preventative migraine medications.  A variety of those meds did not work for me, except Petadolex that can be purchased online DID help me.  But with exceptionally severe, 24/7 migraines caused by a major stroke, I have needed far more.  

And to the rest of you, you can get Botox injections if you have not been helped by the daily meds and have migraines at least 15 days a month.  The Botox has helped me the most.  Also I get nerve block and trigger point injections which also help me a lot.  Plus I have physical therapy exercises which help to loosen up my tight muscles in my neck and shoulders which contribute to the migraines.

So there is a lot of help out there.  You all take care.

Sara
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Avatar universal
Hi again,
It's been a month since I last posted so I have been on amitrip. for almost 7 weeks. I started out feeling exhausted on only the 10 mg and even worse by the time I got to 30 mg. I noticed at the four week point that the headaches were reduced and I was not having migraines. Last week, so week 6, headaches started again. I still have them this week everyday; a stabbing pain on one side of my head. No migraines however for a couple of weeks. Still feel tired but not as badly; definitely have dry mouth all of the time. I have been sleeping ever since I have been taking it and I was not before. My skin is also much more sensitive to the sun. My neurologist advised me to not take pain killers since I will just get used to them and get rebounds. Pre-medication I was taking 4-6 extra strength Tylenol a day. Since the medication, I have taken 1 Advil sporadically when I cannot work through the headache. For the past 2 months I have kept a headache diary and have cut out alcohol, caffeine, fatty foods and have been drinking much more water. I also started taking magnesium.
I see the neurologist next week for a check-up.
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Avatar universal
Thank you for sharing this experience, it is very helpful.  
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Avatar universal
Hi all,
I am currently on amitrip. for migraines. I had daily headaches for several months. For several days in a row, I would also feel nausea, dizziness, and very weak. I tried extra strength Tylenol, Gravol, allergy meds, going to the chiro (to treat vertigo and to make sure it was not a neck problem) and the eye doctor. After seeing my doctor three times and having blood work done (all fine) he sent me to a neurologist. I saw one 4 years back and had an MRI which was fine, so I was then diagnosed with chronic headaches that were made worse by bad posture/stress.

Flash to now, I not only had the one-sided headaches again but the feeling of general unwellness was driving me crazy. My equilibrium felt totally off and I wondered if I had labrinthitis on top of my headaches.
My neurologist did his tests and after hearing me out (how I did not notice a pattern in the headaches, that some days were better than others, could not find a trigger, etc). diagnosed me with migraines. He reminded me that they don't always come with a headache, as I argued that sometimes the symtoms were worse than the headache pain. He told me to lay off on the painkillers and to start with 10mg of amit, then 20mg, then 30mg.

The first week I slept like a rock which was great; my sleep had been terrible for months as the headaches would burn in bed, and I would get terrible anxiety and feel sick. Second week I also slept well, but noticed the tiredness right away. I have now almost been on it a month and my headaches are back. I still feel dizzy as well. I was hoping with time the meds would kick in and help with the symptoms, but now I dont know what is me and what is the meds, since their side effects can be dizziness, fast heart rate, fatigue, etc.
I see the neurologist again in a month and a half, likely to see how I am doing with the meds. I am going to give it another week or two but if I feel the same I may ask to be given something that actually deals with the pain and does not cause dizziness since I already feel off. Fatigue is also hard to deal with, even after getting a long night's sleep.
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Avatar universal
I am 35 years old female with diagnosed 4 years ago Cluster Headaches symptoms. My GP prescribed sumatriptan tablets and a spray to try whatever best worked for me. We started off with 50mg but 2 years ago I have asked for 100mg and if not too severe headache I would half the tablet and take only 50mg. My headaches were really bad with symptoms such as: waking up in pain in the middle of the night, pain in the back of my eye, pain in my neck, watering of the eye; a runny and bunged-up nose; constriction of the pupil in the eye; and absolute photofobia - I would refuse to have the curtains open until the pain was gone.
The headaches appeared out of the blue. Once a month or twice a month and would last between 24-72hours at the time. I kept a diet diary and tested myself for chocolate, wheat, milk & cheese intolerance. Staying away from chocolate does help a lot to lengthen the period between the attacks but the headaches do still occur. I have recently been to my GP to report that migraines occur with unusual regularity linked to my period: I have cluster-headache symptoms 2 or 3 days before my period, every month. I continue taking sumatriptan which always help - not the nasal spray (it never worked for me) but the tablet but I have now asked my GP to investigate further the change of the pattern - she is referring me to neurologist (awaiting appointment) and meantime she asked me to take amitriptyline 10mg every night 3 hours before bedtime. I am starting it tonight.

Also, I have 1 sister, 2 years younger than me. She started suffering from migraines when she turned 30, too. Sumatriptan had awful side effects on her such as feeling nausea, dizziness, tiredness and heart palpitation - she continues with cocadamol and ginger tea but her headaches last a lot longer than mine and she hasn't been able to find a medication that relieves her pain like sumatripan does in my case. The only time she was free of those migraines was the whole pregnancy.

We also wear kitten heels and flat shoes rather than high heels - wearing high heels for 3 or 4 consecutive days guaranteed a headache the next day.

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Avatar universal
i was on amitiptyline for 2 years then it stopped working and my headaches actually got worse. i have tried a zillion meds nothing worked but verapamil. i get the aura and stroke symptoms with my migraines. do you have a PFO? its a hole in your heart. the test for it is called a TEE. a lot of people who have migraines have this. closing it can actually help your headaches. did for me on top of verapamil.

http://www.pfodoctor.org/    - you may want to read about it.

hope you all feel better and get the relief i did. :)
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Avatar universal
My now 13year old son has suffered from severe headache with no relief for about 18 months. Possibly following an infection (he suffered from Pandas as well - no longer). No explanation, no remedy. We will absolutely try this. Thank you som much for your detailed description.
Swedish mom
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Avatar universal
I responded to you over the summer and the post does not seem to be up here. So, now, with a few months of Amitriptyline under my belt I'll report my progress.

My headaches: chronic (more than 15 days) now down to 7. I used to experience pain daily, even if not a full-blown migraine. Now, I have mostly pain free days except for the headache days.

Drugs I am on: Amitriptyline 30 mg, topomax 150 mg, back to back Lutera (bc pills) to halt my period (half pill in am and pm)  with a .1 vivelle dot patch 2x per week to even out estrogen, sertraline between 25 and 50 mg daily, Botox for migraines. Zomig 5 mg pill as abortive (which I often take after Zofran so it works). Zomig spray of I need something fast, or I've eaten (works best for me on empty stomach. I also take magnesium and butterbur each day.

What I have tried: nortriptyline, a beta blocker, more topomax, and anti convulsive. Relax, imatrex, sumitriptan, frova, dhe (migranol). IV treatments. Steroids to halt multi-day headaches.

Summary: the combo of amitriptyline and Botox for migraines has worked the best for me. Prior to that, stopping my period put the biggest dent in my migraine pain cycle. I suspect that my cortisol level was faced by confronting some demons I had been sweeping under the rug, thought I had accepted, but we're really putting my hand over the red button all the time. I do 't know about yours, but my body has a way of saying, "Um, yeah, this is not working for me."

All of this was run by a neuro at Mayo and the only thing he would change is as follows:

1. No real evidence that being on two preventatives works. So, staying on Topomax okay - but I could consider pulling off of that eventually.

2. Amitriptyline can go up to 60mg - if I need to up the ante.

3. I could get an injectable abortive drug (at that time Iw as getting a lot of IV treatments) - like DHE - if I need to up the ante.

That's it. So feel your pain. I've had to be very aggressive in finding a solution. Mine came on very fast and very strong.
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Avatar universal
Make sure you are taking the amitriptyline at the right time, best @ 1/2 hour before going to bed & most important is to get at least 8 hours of sleep. Not enough sleep while taking this med. will be the cause of your headaches. Increasing the dosage at the right rate is very important.& sounds to me that by now you should be @ 50ml. If you aren't taking it at bed time could very likely be the cause of the increased heart rate. I am talking from experience & need to take another med. for my chronic migraines.  
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Avatar universal
Our 8 yr old daughter came down with a virus/ flu like illness (possibly even Lyme) back in March /2013. She developed chronic 24/7 head pain at the onset of this illness that intensified at night. Nothing would touch it. We often slept in our clothes thinking we would be heading back to the ER for an IV of toradol and compazine (which only worked to put her out and pain returned when IV wore off). Long story short we have taken her to cincinatti children's hospital (#3 pediatric neuro hospital in US). They determined she was suffering from "new persistent daily headaches" which are often triggered by a virus or flu like illness. She had been having severe chronic head pain for 7 months!!

She was put on an experimental protocol developed by Dr Hershey there at Cincinnati in which she was to ramp up  amitriptyline very slowly over many weeks . She started at 5 mg and went up by 5 every 2 weeks until she reached the therapeutic level of 30 mg for her. We followed this to the letter for many weeks and became discouraged as we got to 15, then 20 and no response...but then, about 2 weeks into the 20 mg dose we noticed she would have periods throughout the day with no pain!! Then, several days later she went ALL day without head pain which was the first time in 7 months!! It was like a light switch! It took several months but we are SO grateful for her relief!  Apparently you must stay on the drug consistently at a "therapeutic" level for an extended period of time to achieve results. In our case she has now been headache free for about 6 weeks after reaching close to her therapeutic level. I hope this helps someone.  

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Hi, I tried to email you! I am desperate in finding any information that can help us make decision. My daughter is 10 and has been out of school for 3 months now. Started with bad flu/virus and never bounced back. Developed bad headache that has yet to subside. Nausea and extreme fatigue as well. She's been on 10 mg of elavil (amitriptylin) for 6 weeks now with no improvement. I'm scared of increasing the dose?
How is your daughter doing now? Was she going to school all that time? How were her spirits? I'm concerned about the fact that she's taking one dose of Advil and one dose of Tylenol everyday for so long. Please feel free to get in touch! Thx so much
Avatar universal
I have been suffering from cluster headaches since September 5 and they have progressively gotten worse they come everyday about 8 times a day lasting only 30-50 minutes but absolutely excruciating. I recently went to the doctor and she prescribed me sumatriptan 5% nasal spray with one spray in the nasal side where the headaches are and with in 5 minutes they are gone..and oh my god it works I have taken up to 20 % solution and it keeps them gone all day the only problem is my insurance company will only pay for 6 individual sprays tubes a month. I have gone online and found the Canadian pharmacy where u don't need a prescription to buy the sumatriptan at 20%solution a 16 day pack which is 156$ but so very worth it. It keeps the headaches from coming. To all who have not tried I urge you to talk to your doctor because before it I attempted suicide twice because of the pain being so unbearable. I can say the only side effect I have gotten is an upset stomach and I will take that any day over the headaches.
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Avatar universal
How are you doing now?  My headaches sound exactly like yours.  I wake up with them and they progressively get worse through out the day. Sometimes the pain is like a pressurized vice grip, sometimes it is a burning pain.  I have a history of Migraine but these are not Migraine.  My neurologist thinks they are rebound headaches from taking too much Advil and sudafed for my sinuses, which I also have trouble with.  I tried 10mg of Amiitriptyline for 4 weeks but asked to be taken off of it due to not seeing any improvement and gaining weight.  I was hungry all of the time.  He then put me on Topamax, which is not helping.  In fact, my headaches have gotten worse.  I have worked my way up to the maintence dose of 50mg twice a day within the past week and do not care for the side effects that I am experiencing (moodiness, dizziness, fogginess and inability to focus) but my phone calls to my neurologist do not get returned. (Time for a new doctor!). I have a consult with an ENT next week to get his opinion to see if my sinuses are playing a role in these headaches. I would love to know how you are doing now!
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