Nortriptyline, part of the class of drugs known as tricyclic antidepressants, is often used as a preventative to fight chronic pain.
Obviously, as an antidepressant, it’s commonly used to treat symptoms of depression. It works in the chemicals of the brain by inhibiting the reuptake of norepinephrine (noradrenalin) and serotonin. It’s commonly sold under the brand names Aventyl, Pamelor, Norpress, Allegron, Sensoval, and Nortrilen.
But nortriptyline hydrochloride (commonly misspelled as nortriptilyne) has long been used for a variety of other conditions. Some commonly go along with migraine, such as irritable bowel syndrome, fibromyalgia, and TMJ disorder. But it is also used to treat chronic pain, particularly the pain of migraine and tension-type headache, but also cancer pain and arthritic pain.
Sometimes nortriptyline is given along with gabapentin (Neurontin) for certain types of pain. Gabapentin is an anti-convulsant, also prescribed for migraine prevention.
Many drugs in this class are very common in migraine treatment. If your doctor prescribes one, it doesn’t mean that she thinks you’re depressed – though they may be used for migraine with depression as well.
Usually your doctor will start you on a low dosage, and raise it slowly. As is common with migraine treatment, you may need to try it for three months before you can really tell if it works for you. Side effects may diminish over time as well.
This is not likely to be the first drug your doctor will try. Although it the side effects are usually mild, there are still more concerns with this type of drug than with other treatments.
First, be sure you’re working with a doctor who knows your medical history. Nortriptyline can interact with some drugs, and make some more powerful, which can be dangerous. Particular caution needs to be taken if you’ve used a MAO inhibitor drug in the past. Also, if you have any history of seizures or heart conditions, your doctor will probably want to look elsewhere for treatment.
Your doctor will also want to monitor you carefully for the first while, particularly if you have any history of depression. Younger patients (ie teens and young adults) have been known to experience suicidal thoughts early on in the treatment.
However, as I’ve said, side effects are usually mild. These include sleepiness, confusion, dry mouth, constipation (particularly in older adults), and visual problems (including increased sensitivity to light).
Patients that stop taking nortriptyline for migraine often do so because it makes them sleepy. But do discuss the side effects carefully with your doctor – they may diminish or change over time.
That being said, nortriptyline has helped many patients with chronic migraine and tension-type headache. Other good news is that there’s not a high risk of dependence as with some other drugs, and you may be able to take a lower dosage if you’re not being treated for depression as well.
Key points to remember
If your doctor has prescribed nortriptyline, here are a few things to keep in mind:
- This is a common treatment for migraine and chronic pain.
- Be patient; give it three months before expecting a big change in your symptoms.
- Be sure your specialist knows your medical history (particularly a history of heart problems or seizure), and knows about all the drugs and supplements you’re taking.
- Talk to your doctor about the side effects you experience – even if they change over time.
- Don’t change your dosage or stop taking the drug without talking to your doctor.
- If it’s not effective, don’t give up – there are many other options!