Which medications in the drug class Tricyclic Antidepressants are used 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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Answer

Tricyclic Antidepressants

In low doses, tricyclic antidepressants (eg, amitriptyline) are useful in preventing migraines, particularly in patients with cyclic vomiting syndrome. They appear to exert their antimigraine effect independent of their effect on depression.

Amitriptyline

Amitriptyline has efficacy for migraine prophylaxis that is independent of its antidepressant effect. Its mechanism of action is unknown, but it inhibits the activity of such diverse agents as histamine, 5-HT, and acetylcholine. Its mechanism of action may also be central serotonin enhancement, but this has never been proven. When amitriptyline is administered at a low dose, it may be particularly effective against cyclic vomiting of childhood. The drug also has been used for long-term prophylactic treatment of chronic tension-type headache. It cannot be formally recommended for individuals under 12 years.

Doxepin

Doxepin has efficacy for migraine prophylaxis that is independent of its antidepressant effect. Its mechanism of action is unknown, but it increases the concentration of serotonin and norepinephrine in the CNS by inhibiting their reuptake by the presynaptic neuronal membrane. It also inhibits histamine and acetylcholine activity.


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