Tricyclic Antidepressants

Tricyclic antidepressants (here especially Amitriptylin) are often, with great success, used as part of a medicinal prophylaxis for migraine and tension headaches. The American Academy of Neurology classifies Amitriptylin as the most important medicine of first choice. Tricyclic antidepressants (Doxepin, Nortrptylin, Imipramin) and other selective serotonin re-uptake inhibitor (Fluvoxamin, Parotexin, Sertralin, Venlafaxin) are regarded as medication of the 3rd choice.

An overview of the studies at hand show that of all the named antidepressants only enough placebo controlled studies which show a confirmed effect have been done for Amitriptylin. A correlation of the effect on the depression and the prophylaxis of the migraine – as far as studied – did not exist.

The use of other tricyclic antidepressants is based only on experience. The gained experience and the studies prove, for the group of antidepressants, a prophylactic effect for migraine only for Amitriptylin. The needed dose is between 50 – 75 mg a day. The increase of the dose should take place in slow weekly steps pf 10 – 25 mg. Amitriptylin is especially induced when migraine and chronic cluster headache, a depression or insomnia occur simultaneously. However, it should also be taken into consideration for a highly frequented migraine if an alternative to beta blockers is needed.

Contraindicators for the use of Amitriptylin are acute congestive glaucoma, acute ischuria (urinary retention), pyloric stenosis, ileus, enlarged prostate with residual urine generation, severe transition disorder of the heart (bundle branch block, AV-block, 3rd degree). Utilization restrictions are a damaged heart, severe liver function disorder, high disposition for cramps, enlarged prostate without residual urine generation, severe obstipation and blood formation disorders. The most common side effects are fatigue, dryness of the mouth, obstipation, quickend heart rate and weight gain. More rare are dizziness, muscle tremor, impaired vision, liver function disorders, cardiac conduction disorders, blood pressure regulation disorders, glaucoma trigger, ischuria or sexual disfunctions.