Amitriptyline in the Prophylactic Treatment of Migraine and Chronic Daily Headache

Couch, J. R.

doi:10.1111/j.1526-4610.2010.01800.x

Cited by 120 publications

(87 citation statements)

References 35 publications

(168 reference statements)

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“…By today's standards, some of the patients in that study would have qualified as having CDH. Another recent study has provided evidence of successful treatment of CDH with amitriptyline [39].…”

Section: Preventive Antimigraine Agentsmentioning

confidence: 97%

Update on Chronic Daily Headache

Couch

2010

Curr Treat Options Neurol

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Chronic daily headache (CDH), defined as a primary headache occurring at least 15 days per month, is a problem of worldwide scope, which is seen in 3% to 5% of the population. Though it has been recognized since ancient times, only recently have there been attempts to define and classify it. CDH usually consists of a mixture of migraine and tension-type headaches (TTH), with the more severe headaches having migraine features and the less severe headaches fitting the definition of TTH. Some patients have pure chronic TTH and no migrainous features, and others have only migraine, but most have a mixed migraine-TTH pattern. New daily persistent headache, a CDH pattern that comes on over a few days, constitutes 9% to 10% of this group and is otherwise indistinguishable from CDH. Hemicrania continua (1% of CDH) appears to be unique in being absolutely responsive to indomethacin. Accurate diagnosis of CDH is critical to management, as all organic etiologies of chronic headache must be ruled out. Problems often associated with CDH and complicating the diagnosis are head injury or medication overuse (rebound-withdrawal headache). These accompanying issues must be recognized and treated appropriately in the management plan. Finally, psychiatric problems (unipolar depression, bipolar disease, generalized anxiety disorder, and obsessive/compulsive disorder) often accompany CDH, as they are comorbid with migraine. These conditions must be recognized and treated along with the headache itself for treatment to succeed fully. Treatment of CDH is multimodal. The cornerstone of therapy is the use of prophylactic antimigraine medications to prevent or modulate the next headache. Amitriptyline, topiramate, valproic acid, and gabapentin have all had class I studies showing effectiveness in reducing headache occurrence. Recent studies with botulinum toxin have also shown effectiveness in reducing the headache burden. Recognition and treatment of medication overuse headache (MOH) must be carried out as part of the initial approach. Use of acute symptomatic treatments such as triptans or NSAIDs must be undertaken with care, as frequent use of these agents can lead to MOH. Educating the patient about the condition and reasonable expectations for therapy is essential to success. Recognition and appropriate treatment of psychiatric disorders is likewise essential. Adjunctive nondrug therapies and lifestyle changes round out the requirements for a management plan. The chances for long-term remission or significant improvement are up to 65%. The patient and physician must understand that CDH is a long-term process with relapses and remissions. A strong and trusting relationship between patient and physician is a major asset in managing this condition.

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Section: Preventive Antimigraine Agentsmentioning

confidence: 97%

Update on Chronic Daily Headache

Couch

2010

Curr Treat Options Neurol

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“…1). Nine trials compared TCAs with placebo, [20–28] whereas other 3 trials compared amitriptyline with SSRIs or SNRIs [17–19] .…”

Section: Resultsmentioning

confidence: 99%

Tricyclic antidepressants for preventing migraine in adults

Yang

Dong

et al. 2017

Medicine

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“…The average reduction in migraine days, however, is modest: À0.70 (95% CI À0.93 to À0.48). That tricyclics may not belong to the most potent preventive drugs for migraine is also suggested by the results of the largest placebo-controlled trial of amitriptyline (100 mg) performed 30 years ago but published in detail only in 2010 [38 ]. In this study, 338 patients were randomized and 55% of them followed for up to 20 weeks.…”

Section: Pharmacological Treatmentmentioning

confidence: 89%