If you use amitriptyline for migraines...

[Fitzcarraldo353]

Can I ask about your experience?

I've been prescribed 20mg to be taken daily to try and keep my migraines at bay. I've been trying to tweak my HRT to see if that would help first, but it hasn't, so may start taking these.

Can I ask those who are already on it, how drowsy did it make you at first? I need to time starting it carefully if it's going to make me crazy sleepy in the day (I know you take them at night for that reason).

I've also been started on 20mg - is that the starting dose most people have tried?

My migraines are not totally debilitating - I can take painkillers and still largely function - but they have gone from being monthly to weekly (or more) so I'm spending a lot of time feeling exhausted, nauseous and brain foggy. I was trying sumatriptan but don't find it does much to help and also has some additional side effects.

I'm feeling a bit nervy about taking these also because apparently you have to wean yourself off them carefully which sounds weird.

Any help/advice much appreciated!

I take them and it was a game changer once I got the dose right. My migraines had got so much worse as I entered perimenopause.

I was started on 10mg and then went up by 10mg after a few weeks (I think it was a month), and then by another 10mg to 30mg which has been the dose I’ve stayed on and it works really well.

The first week or two I was REALLY tired in the mornings. It wore off through the day, but I had to take them at about 6-7pm to give me any hope of being able to get up early enough to go to work. I was worried it would happen again when I upped the dose, but it didn’t seem to. That effect didn’t last all that long really, once I adjusted to it. The other side effect, that has improved but is still noticeable, is that it gives me a dry mouth over night.

Not for migraines but I did find it left me tired to start. Doesn't really affect me now but I've been on it years.

I couldn't get past the sedative effects and had to come off it. I was in the police at the time and it was so dangerous for me - I couldn't drive, I couldn't think straight and it was just unrealistic to carry on.

That said, I know other people for whom it was hugely effective and the sedation wore off.

I'm under neurology these days after years of ineffective medication and I'm currently on Aimovig injections.

Like @PaintDecisions I was too sleepy to continue, even starting at 10. But I have known people find Amitriptyline very effective.

If your attacks have become this frequent you could ask for a neurology/ headache specialist referral. This would open up more options of both preventative medicine (you will usually have to have tried 3 first line preventative meds first before) and rescue medication - i.e. Vydura (rimegepant) which does not carry the side effects of the triptans.

Thanks for sharing your experience so far.
I'm currently not working, so it seems like it might be a good time to try it. DH can make sure everyone is up in the morning etc. and obviously Easter holidays are coming up too. I've just been trying to find a gap between job interviews so I'm not dopey if they come up!

Interesting @Conqueeftador that you started on 10mg and worked up from there. I'm a bit worried about starting off on 20 and it TOTALLY wiping me out. I'd consider going back to GP to request 10mg starting dose but that might take a few weeks to get an appointment and I might miss a window to start.

Sorry it didn't work out for you @PaintDecisions but glad you have treatment that's working for you now. Although the frequency of mine is rubbish, the severity means I probably won't go for stronger treatments at this point.

Thanks @SwedishSayna . That's good advice I can look into.

I wasn't prescribed it for migraines but it's brilliant, I started on 75mg and gradually increased until 150mg. I haven't been on it in probably 4/5 years now and didn't have any issues coming off it, gradually reduced the dose over a period of weeks and then start missing every other day, then two days, then 3...etc. At that point stopping completely.

The sedative effect was really rough but other than that no side effects and if I needed to I'd start taking it again without hesitation.

Obviously best to take before bed, if you're struggling you could try a lower dose and build up

Just snap the tablets in half for a few days and build it up.

Severity is only one element though. There's a lot of emerging evidence that poorly managed and controlled episodic migraine is exponentially more likely to become chronic. And it seems you're heading towards chronic.

https://migrainetrust.org/understand-migraine/types-of-migraine/chronic-migraine/#:~:text=Chronic%20migraine%20is%20defined%20as,frequent%20headache

I did well with pizotifen but eventually for me (over the last 30 years) all preventative treatments have failed.

Botox was great, halved me from 27 days a month to 12-15 but I was still struggling.

If sumatriptan isn't working for you, there are another six triptans to try. If you get nausea consider asking for a nasal spray or under the tongue version next as gastric stasis stops you actually ingesting the meds into your bloodstream which stops them being effective of course.

I know far more about migraine now than most GPs 😂 so I just tell them what I want. Usually works, but I also go in armed with a copy of the NICE guidelines and talk them through it.

https://cks.nice.org.uk/topics/migraine/management/adults/

I don't take it for migraines but I'm on 10mg and it doesn't make me drowsy at all, even when I've taken 20mg on the odd occasion. I think it's quite personal and you won't know until you try so start with a low dose in the evening and see how you go.

I only took it once, had a massive allergic reaction and ended up in hospital. Not common I know but that's my experience!

@PaintDecisions I'm the same, I'm incredibly knowledgeable about migraine and almost none of my knowledge comes from doctors telling me. I got massively burned when a GP prescribed an opiate painkiller and I ended up with a six month headache. Now I understand that opiates are not advised for migraine.

OP as @PaintDecisions says the Migraine Trust are brilliant. The national migraine centre also have a good podcast called Heads Up.

@PaintDecisions thank you. I'll do some research! Really appreciate you're info and experience.

@TheCurious0range sorry to hear that. I've got food allergies so I know how terrifying that can be! Glad you were ok

Just realised my prescription is for 25mg, not 20 and says to take TWICE a day which seems like a lot to start off with? I mean, obviously I can just take fewer of them, and attempt to even take half a table, although they're pretty teeny so don't look easy to cut/break.

Not making me feel like my GP totally knows what she's doing with migraine treatment though. She was alternatively trying to convince me to take propranolol which is a beta blocker and seemed totally surprised when I told her that I couldn't take that because it inhibits adrenaline so would decrease the efficacy of my epi-pens if I needed to use them.

I did also mention all of this to my gynacologist when I was seeing her for something else perimenopause related. She was suggesting coming off HRT but I don't want to do that because a) the HRT is working for my other symptoms and b) I had monthly migraines before going on HRT anyway!

Going to call the migraine trust helpline and go from there I think.

Wise to be cautious OP. I'm not a doctor but 50 mg a day sounds huge as a starting dose. Good idea to check out the migraine trust advice.

I was started off on 5mg a day to gradually build up to 10 mg and am just about to go up to 20mg.

I started on 10mg when pregnant with dd1. The sleepiness was horrendous, I fell asleep quickly, deeply and waking up was a struggle. I eventually had to take them at about 8:30 and go up to bed by 9 just to be able to get up for work in the morning and that wasn't until 7:30ish. I only took them for about a month though as they had to be stopped by third trimester. With dd2 dr suggested cutting them in half as I was clearly sensitive to them and this made it marginally better, my sleep was as deep but it was a little bit easier waking up. They stopped my migraines though, I dont think.i had a single one after a couple of days of taking them.

I take 10mg and that has stopped my migraines completely. The side effects were very rough to begin though. Nausea, headache, vertigo, dry mouth were all bad for a couple of weeks. But then they passed and now no migraines so well worth it

I think i started on 10mg then after a week or maybe 2 weeks upped to 20mg once a day. I take it by 7pm so that it wears off by the morning. The first few weeks i was fast asleep on the sofa by 9pm. I felt like i had jet lag for the first couple of months. But now its not like that. Im ok during the day. I do find it harder to get out of bed in the morning. I used to be a real morning person but it now takes me 30mins to wake up and get out of bed. Its been great for my vestibular migraine prevention.

I use this for my arthritis. I take it at night and I feel so tired and whacked out the next day. But I will say, medication has different effects on different people. Just give it try and see his you get on.

I started on 10 mg. Initially it made me very groggy in the morning. I set an alarm to take it about 8.30pm so it eases off before I wake. I would suggest asking for a lower starting dose. I have been on 35 mg for a while now (gradually increased). It’s reduced the frequency and severity of my migraines. I have Sumatriptan nasal spray for when they do occur which is brilliant. Gone from 1-2 a week lasting 2-3 days where I struggled to get out of bed to 1-2 a fortnight that are nipped in the bud by the Sumatriptan.
One interesting observation- I decided to radically reduce my consumption of ultra processed foods after reading Ultra-processed people. Been doing it for 4 weeks and the only migraine I’ve had was the morning after I ate a shop bought sandwich!

I started on 10mg and went up to 20 but I couldn’t tolerate the 20, it brought on a shocking migraine in the middle of the night.

I had an appt with National migraine centre and one of the things they advised was a supplement called Dolovent and omg it’s been life changing. I feel SO much better overall (I don’t think I realised just how generally rubbish I felt) and haven’t had a migraine in a month. It’s early days but I’m hopeful!

Started on 10mg in January 23 with a view to rising to 30mg but that was before I landed up in hospital - I’m on it long term for what was a back issue and now take daily 20mg.

It is a weird drug sometimes I get good sleep and other times spend the early hours awake.

I was told yesterday by the eye specialist once you get past 40mg on a daily basis it is considered an anti-depressant not a muscle relaxer.

I found it really sedating tbh. I switched to candersartan to control blood pressure which they reckoned was cause of migraines.

It knocks me out cold so I can’t take it unless I’m going straight to bed and don’t need to be anywhere the next day.

I take 20mg for migraine.
i take it about 10pm, and am usually fine the next morning. If I take it later than that, I feel drowsy still. But I am a terrible sleeper and before I started taking it, I was sleeping on average five hours of sleep a night. So the drowsiness was a welcome side effect. I forgot to take it last night and I was back to waking at the crack of dawn.
It’s made a difference with the migraines, whereas propanalol did not. I have had one really bad migraine since starting it whereas I would have had them every other week before.