Treatment with Amitriptyline, also known as Saroten

The medication

Amitriptyline was primarily developed to treat depression, but it has subsequently been shown to be effective for migraine and chronic tension-type headache as well. The medication is therefore not being prescribed to you for its antidepressant effect, but because amitriptyline is the best-documented treatment for chronic tension-type headache. 

Mechanism of action 

Amitriptyline increases the concentration of pain-relieving substances in the central nervous system and promotes a more restful night's sleep. 

Amitriptyline does not eliminate the headache, but a realistic treatment goal is a 30% reduction. For some, it may be more; for others, less. The effect of amitriptyline usually begins after 1-3 weeks. 

Side effects 

The most common side effects are dry mouth, fatigue, and weight gain. Your appetite may increase without you noticing, but your metabolism does not change. It is therefore recommended to check your weight regularly. Amitriptyline does not affect your metabolism, so you can prevent weight gain by eating as you normally would. 

Precautions 

Alcohol can intensify the sedative effect. Thorough brushing and regular dental check-ups are important, as dry mouth increases the risk of cavities. You should exercise caution when driving during the initial phase of treatment. 

Before starting treatment 

Before you begin treatment, an electrocardiogram (ECG) must be performed. If the final dose is 40 mg daily or higher, the ECG must be checked again one week after the final dose has been reached. 

What dosage should you take

The starting dose is 10 mg for one week. Thereafter, the dose can be increased by 10 mg per week until the desired effect is achieved or bothersome side effects occur, up to a maximum of 70 mg per day, unless otherwise agreed with your doctor. We recommend that you take the medication 1-2 hours before going to bed. 

Once the correct final dose has been determined, it should be taken daily for 6-12 months, after which the dose can often be slowly tapered off in consultation with your doctor. However, some patients may need to use amitriptyline for a longer period.