Nortriptyline for Chronic Pain

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.

Important notes:

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!

More on nortriptyline from Drugs.com

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29 comments… add one

  • Christine May 18, 2010

    Yes! I take this and have for years, for migraine. For 20 years I woke up everyday with a headache, and when my doctor put me on a low dose of Nortrip. these headahes vanished! I only take 25mg/bedtime and have not had any bad experiences with the side effects. I have since also been diagnosed with fibromyalgia, so I am thinking this Nortrip. is helping that as well. PLUS I love the fact that Notrip. is one of the $4 medicines available at WalMart :)

    • James Jun 23, 2010

      Nothing like an inexpensive medication that actually works for you! :)

  • RhondaL Jun 17, 2010

    Just a heads-up, I took Nortripyline for about a year and gained a lot of weight on it. So, that’s something to ask the doctor about.

    • James Jun 21, 2010

      Yes, weight changes are a possible side effect of Nortriptyline. In other words, gaining or losing. But it’s not as common as some of the other side effects.

  • Melinda Jun 21, 2010

    Thanks, James! I’ve had migraines for about 10 years and transformed migraines for over 4. When I met my current neurologist, I was experiencing what felt like the same headache for 6 weeks straight. He switched Neurontin for Topamax, and when I lost a great deal of weight, he suggested we try Nortriptylin. We’ve leveled off at 40mg daily–also taken at bedtime–and except for accidental food triggers, I have been blessedly pain-free.

    • James Jun 23, 2010

      That’s great! And how are things going with the food triggers? Are you able to avoid them?

      • Melinda Jun 23, 2010

        I have a pretty good handle on the food, although it took me years to really get it. I’m a textbook tyramine case, but I think of it as “aged protein”–no nuts, no cheese, no deli meat, no leftovers. Of course it’s more complicated than that, but it makes it easier to explain to waiters and coworkers.

  • Scott Nov 23, 2010

    Just started taking this medication for sleeplessness due to chronic back pain.. Also have suffered from Migraines in the past.. I hope this will provide the relief and sleep needed to regain my normal daily routine..This is a substitute for the more addictive and less afffective valium and xanax taken in the past..Any opinons or similar cases would be appreciated on the effectiveness of this drug..Thanks..

  • marylyne May 27, 2011

    My doctor just put me on Nortriptyline today 10mg I have been throwing up and very tired the next day. Is this expected, and I am concerned about gaining weight on this drug even though it is a low dosage.

  • Sarag Jun 25, 2011

    I have been taking Nortriptyline for about a year now for migrane prevention. I am taking 20mg a night, and found that my migranes diminished completely. I tried to lower the dose myself, and started taking 10mg a night, and learnt after about 6 weeks of doing this dose that it was too low, as the migranes returned. I have not put weight on taking it, so it is fantastic for me

  • trina Dec 24, 2011

    i have been dealing with migranes for years and have tried several medications with little help or no help. i am now taking nortriptyline 25mg and the doctor wants me to increase up to 75mg in about 3 weeks. but i also have anxiety and depression and take cymbalata 60mg. i have read up on nortriptyline is given for depression /anxiety too. so i am wondering if i can stop taking cymbalata and just take nortriptyline. i am 31 years old and take enough rx medications. i do have appt to see and talk to my doctor about the possible change too. but i just wanted someone’s opinion before then.

    thanks

  • Sarah Dec 28, 2011

    I have just gone back on Nortriptyline, after going off it and trying topamax, as i also have a tremour which I thought I could kill two birds with one stone by using topamax. The side effects I haad on topamax were just not worth it. Nortriptyline is just a godsend for me with my migranes, so I am sticking to it now

    • MARGO Nov 7, 2013

      I had a terrible reaction to topamax, it irritated my stomach so much I ended up with severe gastritis. I am now on 10mg of nortriptyline for the migraines. I have been on it for three weeks but have not seen a great decrease in frequency of headaches but they are not as dibilitating as before so hopefully as I am on it longer I will see a decrease in the headaches. The quality of life goes down the drain for those of us aflicated with these headaches.

  • Jocelyn Mar 12, 2012

    Have anyone taken this Med for MS pain?

    • kazinmich Jul 26, 2012

      Jocelyn,

      I take this for my neurological pain caused by MS. I get the tingling, burning, twitching sensations down my arms and in my face/neck that drive me insane. Since taking this – 50mg at bed time – my neurological feelings have been gone. The only time they act up is if I push myself too hard or get too stressed. I also no longer have migraines, so this has been great for me!

      • dale Sep 28, 2012

        is anyone still paying attention to this forum everytime I find one that has somewhat to do with me, noone replies.

  • pam Apr 21, 2012

    I was taking nortrip. And had the worse dreams ever. So I stop taking it .Now I have nerve pains in my legs. Arms and hands . What to do….

  • Elnora Apr 25, 2012

    Nortriptyline has been more or less a miracle drug for me. Before I started it, I was getting headaches every single day and severe migraines 2-3 times a week. Within a few days of starting the drug, the daily headaches were gone and the migraines reduced to maybe once a week. When I do get them, they are less severe and respond better to triptans. I gained some weight on the nortriptyline and tried to reduce the dose, only to have the headaches come back. I upped the dose and the headaches went away again. Now, I don’t care about my weight…..it’s an acceptable trade off for the pain relief. Even better, my month’s supply of the drug only runs me about 4 dollars. I highly, highly recommend nortriptyline to anybody suffering from chronic migraines and daily headaches.

  • kim Jun 14, 2012

    im currently taking Nortriptyline. i think its making me depressed. i was so angry at myself a day i thought of stabbing myself with a knife&i till cant get it off my mind. i just feel like hurting myself. my doctor recommended it for headaches. is it possible that d medication is causing a bad side effect on me.

    • KT Jun 15, 2012

      Kim I read that feelings of self harm can be a side effect, you should definitely talk to your doctor asap. Make sure you are near someone who can look out for you while you’re feeling like this. Don’t listen to those feelings you’ll be ok just go and see you doctor. Take care!

  • Jane Jul 25, 2012

    I have severe osteoarthritis, stenosis and bulging disks at L 4-6 and have just been started on Nortrip. Has this been of help to anyone else with back problems?

  • Stavesacre Aug 12, 2012

    I have been taking this drug for about 3 months for testicular pain , and the pain is gone I take 50mg at night , I also have had terrible migraines as well and I have no pain , happy happy(;

  • Cher Aug 31, 2012

    I am taking numerous medication, I mean numerous. Some for back pain, neck pain, depression, headaces, anxiety, knee pain and fibromyalgia. A close friend told me about this medication. I am going to my doctor to ask her about this. I will let you guys know what happens. I am so excited. If I can take one pill instead of these others that are addicting, I will be so happy and hopefully, painless or at least in less pain. Cher

  • dale Sep 28, 2012

    I have been going to therapy and the therapist recommended I have primary physician perscrribe me an anti depressant. I didnt have great results with celexa or cymbalta so I am starting Nortriptyline at bedtime tonight. Also I have been having very flush feeling face, migraines, dizzyness, annyoying numb right foot very often, faint feeling when I go out in public or to work.I have had the migraines for alot in life but everything else seem to intensify after loss of my father. I had had many tests MRI, cardivascular test, ekg. cspine xrays, bloodwork done on a few instances and everything comes back ok or normal so they say But I have missed more work FMLA etc for these symptoms. I do visit a chiropractor for pinched nerves, go to therapy, on blood pressure meds and gabapentin, seen a neuro surgeon. I dont know what more i can do but i dont believe these numbness and faint feelings are just in my head.

  • Leslie Oct 10, 2012

    I have a history of back problems since I had surgery (laminetomy L-4-5) 21 years ago.I started getting sharp pain into my groin area and went through the whole mess again with MRI’s ect. I was told my pain is from my back although I do have arthritis in my hip.My Dr. put me on Nortriptyline(25mg.) I was wondering if there are other people with chronic back pain who have tried this med and how well does it work because even narcotic meds barely take the edge off my pain and then only briefly.

  • Mindy Oct 31, 2012

    Have any of you ever had your hands hurt & tingle while taking Nortriptyline? My daughter is taking it & woke up with them hurting really bad. I called the dr & he said she should keep taking it but I’m worried cuz online it said that could be an allergic reaction. Just wondering if anyone else had this happen

  • Leslie Nov 3, 2012

    After trying the nortriptyline (25mg) I felt no diference the Dr. put me up to 50mg and I felt really depressed.I have been told by my primary physician that I have A.D.D.and that I have adverse effects of most meds.for example, valium/ xanax gets me going and antidepressants make me more depressed to the point I don’t want to get up or do anything..I feel like I am wired backwards.Is there anyone else have any answers?It seems all the Drs. wantto load me up with tons of these antidepressants which make me feel horrible and what really works for my back pain (narcotics) they won”t give me because it”s addictive.Whats the difference if I have to take something every day anyway?[email protected]

  • TW Apr 18, 2013

    I’ve been taking this med for 3 weeks for migraines, chronic pain and sleeplessness . Two weeks was at 25mg and now I’m taking 50mg.
    Neither doses have had any significant help to me but plenty of side effects. I’m not sleeping anymore that my usual 3-4 hrs per day, I’ve gained about 6#, haven’t had any sweet cravings though, still have 1-3 migraines per week, chronic pain back/neck and constipation and severe rashes on my face, neck and chest (left dark marks)
    I know it a few months to know if a medicine works but I don’t think this one is working and my Dr doesn’t seem concerned by the adverse effects. I have added more veggies to my already lean low-fat diet to see if that helps w the weight gain and drink lots of water (10c).
    ANY THOUGHTS?

  • Michelle Renee Dec 2, 2014

    This drug saved my life twice!

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