What is the role of tricyclic agents and cyproheptadine in the treatment of pediatric headache?

Updated: Jan 02, 2019
  • Author: J Ivan Lopez, MD, FAAN, FAHS; Chief Editor: George I Jallo, MD  more...
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Tricyclic agents (amitriptyline, nortriptyline) are frequently used for prophylactic therapy, especially in older children and adolescents. Nortriptyline tends to be less sedating than amitriptyline, but there are no well-conducted scientific trials demonstrating the efficacy of nortriptyline. There is, however, plenty of scientific evidence that amitriptyline is efficacious in migraine prevention. A paper presented at the American Academy of Neurology Annual Meeting in New Orleans (2012) showed that amitriptyline was safe and effective for migraine prevention in children and adolescents.

Cyproheptadine (Periactin), an antihistamine/antiserotonin drug, is also used, especially in younger children. Side effects include sedation, appetite stimulation, and weight gain.

No good scientific evidence supports the use of tricyclic agents or cyproheptadine in the pediatric population, but many clinicians have used these medications with success over decades.

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