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tricyclic antidepressant

16 November 2015

Good News for Children with Vertigo

James Discoveries & Stats, Medications 1

What causes vertigo in children? Common causes would have to include the inflammatory diseases known collectively as otitis media. Otitis media will often go away by itself, and the symptoms can be managed by mild pain killers. In some cases, antibiotics may be needed. If the disease keeps returning, your doctor may recommend “tubes” in the ears to help drain the fluid. (More about Middle Ear Infections)

But next to that, there are many children who have vertigo which is harder to diagnose. If the eardrums look normal, and there are no inflammatory diseases, what’s the solution?

Well, we have good evidence that the most common cause of this vertigo is migraine. According to one study (see Various causes and clinical characteristics in vertigo in children with normal eardrums.), migraine and benign paroxysmal vertigo of childhood (BPVC) account for over half of the cases of vertigo, the rest being more tricky.

How can this possibly be good news?

Well, catching migraine early in life leads to some major benefits later one. Also, getting a proper diagnosis (as opposed to “just lie down if you feel dizzy… maybe it’s stress…”) can lead to much better treatment.

Child Vertigo Researchers and health professionals are still trying to figure out what to do with dizziness in migraine, especially if it is a major and repeating symptom. Sure, we know some clear types of migraine where vertigo is common, but the rest of the cases are harder to classify.

So we have a category that we call “vestibular migraine”. In vestibular migraine, the vertigo is moderate to severe, and it happens multiple times. At least 50% of the episodes have some of those common migraine symptoms, such as a one-sided headache. But sometimes the vertigo just comes by itself.

Some of these attacks can last for hours – even days. And if the symptoms are severe (even if there’s no headache), the patient will be completely unable to carry on with normal activities.

But the good news is that these episodes can be treated with typical migraine medications and treatments (which also further confirms their connection to migraine disease).

Last month a report came out of Boston Children’s Hospital, illustrating some of their experience with children with vertigo, and in particular vestibular migraine (Evaluation and management of vestibular migraine in children: Experience from a pediatric vestibular clinic.).

When the patients tried the following medications (all of which are drug types used for migraine), 80% or more were successfully treated:

tricyclic antidepressants
cyproheptadine (an antihistamine)
topiramate
triptans

Gabapentin, which is an anticonvulsant, was also used. It was effective in 25% of cases.

If your child complains of dizziness (and possibly nausea), and is also getting some headaches (not necessarily at the same time), talk to your doctor as soon as possible. If there is no obvious ear problem, there’s a good chance that migraine is to blame.

Because any of these diseases (migraine, otitis media, BPVC) can have a major impact on your child’s normal activities and development, it’s very important to get proper treatment as soon as you can.

17 May 2010

Nortriptyline for Chronic Pain

James Medications 85

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