Amitriptyline in Migraine Prophylaxis
Melissa A. Walker
Kevin J. Staley
Effectiveness of Amitriptyline in the Prophylactic Management of Childhood Headaches
Hershey AD, Powers SW, Bentti AL, et al. Headache. 2000;40(7):539–549
Background
Worldwide prevalence of headache in children is approximately 60%, with significant associated morbidity, including school absenteeism and impaired interactions with family and peers.1,2 In the 1970s, several studies established amitriptyline as one of the more effective and better-tolerated adult migraine prophylactic agents, with an average efficacy of 42%. This was the first large-scale pediatric study.
Objectives
To assess the effectiveness of amitriptyline for pediatric headache prophylaxis.
Methods
Prospective observational study in a single outpatient headache center from 1997 to 1999.
Patients
192 school-age patients who reported >3 headaches per month. Select exclusion criteria: prior prophylaxis, initiation of another medication.
Intervention
Amitriptyline was started at 0.25 mg/kg nightly (slowly titrated to 1 mg/kg) and continued until development of intolerable side effects, lack of adherence, lack of benefit at 3 months, or successful treatment for 4 to 6 months (reduced headache frequency to ≤2/month). Baseline and follow-up characterization of headaches (using a standardized questionnaire) and school attendance were recorded at regularly scheduled visits.
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