Treatment with Amitriptyline, also known as Saroten

The medication

Amitriptyline was primarily developed to treat depression, but it has later proven effective for migraine and chronic tension-type headache. You are not being prescribed this medication for an 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 is 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. Appetite may increase without you noticing, but your metabolism does not change. It is therefore recommended to check your weight regularly. Amitriptyline has no effect on metabolism, so you can prevent weight gain by eating as usual.

Precautions

Alcohol can intensify the sedative effect. Thorough tooth brushing and regular dental visits are important, as dry mouth increases the risk of cavities. You should be cautious when driving at the start of treatment.

Before starting treatment

Before starting 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 is 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 an 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 taking the medication 1-2 hours before bedtime.

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