Does Nortriptyline Treat Migraine? Benefits and precautions

Migraine is not just a headache. More than 4 million adults suffer from this neurological condition every day, which involves chronic pain and nausea, among other symptoms.

Migraine can be difficult to diagnose — and even harder to treat — which means many people seek emergency care when they can’t find relief. In the United States, more than one million emergency room visits each year are related to migraine pain.

During a migraine attack, there is a drop in serotonin levels. While researchers are thinking outside the box to treat migraine, some have found that antidepressants that balance serotonin levels may be helpful in preventing migraine from occurring in the first place.

Keep reading to learn more about the role of tricyclic antidepressants (TCAs) in migraine treatment and what you need to know before taking them.

Nortriptyline is a tricyclic antidepressant. This class of drugs acts on the central nervous system by increasing the level of serotonin in your brain. Serotonin drops when a migraine attack occurs.

Tricyclic antidepressants like nortriptyline are generally used to treat depression, but there is some evidence that they may also be beneficial in the treatment of migraine.

There are many theories about the causes of migraine. One of them involves an imbalance of neurotransmitters like serotonin. There are several types of medications that can help balance these neurotransmitters, and nortriptyline is one of them.

While other medications can be used to treat many migraine symptoms, antidepressants like nortriptyline can be helpful in preventing them.

There are a number of side effects of tricyclic antidepressants. While they can be helpful in reducing migraine attacks, there are also serious risks to consider.

The Food and Drug Administration (FDA) has issued a Black Box warning — the agency’s strongest warning — for nortriptyline. The warning notes that taking this drug may actually increase depression in children, teens, and young adults, leading to episodes of major depressive disorder (MDD) and even risk of suicide.

The most common side effects of this drug include:

  • nausea
  • drowsiness
  • weakness
  • fatigue
  • anxiety
  • nightmares or trouble sleeping
  • dry mouth
  • changes in appetite or weight
  • constipation
  • changes in urination
  • changes in libido
  • excessive sweating

Medical emergency

More serious side effects have also been seen in people taking this drug. Seek immediate medical attention if you experience:

  • muscle spasms in the jaw, neck, or back
  • speech changes
  • a shuffling walk
  • tremor
  • fever
  • difficulty breathing or swallowing
  • eruption
  • yellowing of the skin or eyes
  • irregular heartbeat or palpitations
  • increase in depression
  • suicidal thoughts

In Clinical studies, nortriptyline and other TCAs significantly reduced the frequency of migraine attacks. Other classes of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), have also worked well.

Your doctor will consider your specific medical history and tolerance to these medications when choosing the right treatment for you.

These medications are effective in reducing the frequency of migraine attacks because they help balance levels of neurotransmitters that may play a role in the development of migraine. Other medications may be used to manage symptoms when migraines occur.

Like many other antidepressant treatments, nortriptyline treatment starts with a small dose which can be increased in stages until you have reached a therapeutic level. The drug is available in 10 milligram (mg), 25 mg, 50 mg, and 75 mg formulations.

The dosage usually starts at 25 mg taken at bedtime. You and your doctor will discuss a plan to increase this dose as needed until your migraine attacks are significantly reduced.

Doses are increased in 25 mg increments, with one week between each dose increase. The maximum dose is 150 mg per day for adults.

Nortriptyline is only available with a doctor’s prescription. It comes in pill or liquid form. It is available as a brand name drug (Pamelor) or a generic drug.

If you regularly have migraine attacks, make an appointment with your doctor. If you don’t have one, you can use the Healthline FindCare tool to find one in your area.

There are many ways to treat migraine, and no one treatment is right for everyone. Here are some of the ways migraine can be treated.

Over-the-counter medications

Over-the-counter medications may work for some people. Examples of these medications include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as:

Prescription drugs

A number of prescription medications can be used to treat migraine pain and the many other symptoms that can accompany them.

Medications to stop migraine attacks or treat migraine pain include:

  • ketorolac (Toradol)
  • dihydroergotamine (DHE-45, Migranal)
  • ergotamine (Ergomar)
  • ergotamine and caffeine (Cafatine, Cafergot, Cafetrate, Ercaf, Migergot, Wigraine)
  • methysergide (Sansert)
  • methylergonovine (Methergine)
  • almotriptan (Axert)
  • eletriptan (Relpax)
  • frovatriptan (Frova)
  • Naratriptan (Amerge)
  • rizatriptan (Maxalt, Maxalt-MLT)
  • sumatriptan (Imitrex)
  • sumatriptan and naproxen (Treximet)
  • zolmitriptan (Zomig)
  • codeine
  • meperidine (Demerol)
  • morphine
  • oxycodone (OxyContin)

For the nausea that can sometimes accompany migraine attacks, your doctor may prescribe medications such as:

Nortriptyline is not the only drug used in migraine prevention. A number of treatments are available and include:

  • erenumab (Aimovig)
  • fremanezumab (Ajovy)
  • atenolol (Tenormin)
  • metoprolol (Toprol XL)
  • Nadolol (Corgard)
  • propranolol (Inderal)
  • timolol (Blocadren)
  • diltiazem (Cardizem, Cartia XT, Dilacor, Tiazac)
  • nimodipine (Nimotop)
  • verapamil (Calan, Covera, Isoptin, Verelan)
  • amitriptyline (Elavil, Endep)
  • fluoxetine (Prozac, Sarafem)
  • imipramine (Tofranil)
  • paroxetine (Paxil, Pexeva)
  • sertraline (Zoloft)
  • venlafaxine (Effexor)
  • divalproex-sodium (Depakote, Depakote ER)
  • Gabapentin (Neurontin)
  • levetiracetam (Keppra)
  • pregabalin (Lyrica)
  • tiagabine (Gabitril)
  • topiramate (Topamax)
  • valproate (Depakene)
  • zonisamide (Zonegran)
  • Botulinum toxin type A (Botox injections)

Lifestyle changes

One way to manage migraine is to make lifestyle changes. There are many migraine triggers in the foods we eat, stress, and other factors.

Below are some dietary, situational, and complementary lifestyle changes you can make to help manage migraine:

  • Avoid eating foods high in nitrates, such as processed meats.
  • Keep a diary of foods or activities that trigger migraine attacks.
  • Use herbs like lavender, feverfew, peppermint oil, and ginger in home remedies.
  • Add magnesium to your diet with supplements and foods like legumes and whole grains.
  • Try to manage everyday stress.

Migraine is a complex neurological condition that can cause many painful symptoms. There is no single treatment that works for migraine, and most people use several therapies to manage their migraine pain.

Antidepressants like nortriptyline are a class of drugs that can help reduce the frequency of migraine attacks, but they can have serious side effects. Talk to a doctor if you need help managing migraine.

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