Woman With MigraineTricyclic antidepressant, like nortriptyline, can be an effective prophylactic treatment for migraines. Most guidelines recommend them as a "second-line" treatment option behind other drugs like Topamax and Depakote. They can be an especially effective choice for those who are also treating other conditions like depression or anxiety, as tricyclic antidepressants are indicated to treat them.

Studies show that tricyclic antidepressants like nortriptyline increase the chance of at least 50% improvement in headaches by nearly 80% when compared to placebo. While studies vary, the average number of migraines decreases by about 1.4 per month for individuals taking the medication. As nortriptyline is also used for anxiety, depression, it may be a good choice for prophylactic treatment of migraines in individuals with concomitant disease states.

Nortriptyline Dosing For Migaines

In terms of dosing nortriptyline for migraine prophylaxis, the doses used in studies range from as low as 10 mg per day to as high as 150 mg per day, although doses over 100mg per day for migraine prophylaxis are uncommon. The majority of studies initiate nortriptyline on a relatively low dose, between 20mg and 30mg per day. Like many medications, it is generally beneficial to start at a low dose and increase to effect, as long as each subsequent dose is well tolerated.

There may be situations where nortriptyline is started at higher doses as well. If you are also treating depression or anxiety, the effective dose is often higher, around 25mg three to four times daily. The entire daily dose can be given all at once as an alternative regimen, meaning that 75mg to 100mg as a single daily dose isn't uncommon.

So, if you are using nortriptyline solely for migraine prophylaxis, 75mg would be considered a higher than the usual dose, but still within the recommended dosage range. More typically, you would be started between 10-25mg and increase to effect. If you are also treating depression, anxiety or insomnia in addition to migraine prophylaxis, the starting dose may be higher. 

Additional Information About Nortriptyline

When comparing nortriptyline to other tricyclic antidepressants such as amitriptyline, studies show that it may not be as effective, but is certainly better tolerated for most individuals. That is why is may be used first instead of the more commonly used amitriptyline.

Potential side effects of nortriptyline include:

  • Dry mouth
  • Constipation
  • Urinary retention
  • Cardiac effects
  • Confusion

As nortriptyline can be sedating, it is often dosed in the evening.