Amitriptyline in the treatment of primary headaches

Prophylactic treatment of primary headaches should be considered if the patient has severe or frequent attacks and if management of the acute attack is inadequate. The tricyclic antidepressant, amitriptyline, is widely used for the prophylactic treatment of migraine and tension-type headache. In spite of its extensive use, amitriptyline has only been studied in few controlled trials in migraine. These studies indicate, but do not prove, that amitriptyline is effective in migraine. Amitriptyline has been shown to be moderately effective in chronic tension-type headache in several controlled studies, but the use is often hampered by side effects. Conclusive studies regarding the efficacy of amitriptyline in migraine are much wanted. There is great need for development of more efficacious drugs with fewer side effects for the prophylactic treatment of primary headaches.