Amitriptyline for Pain and Migraine

What is amitriptyline for pain and migraine?

Amitriptyline is a tricyclic antidepressant (TCA) that is widely prescribed in low doses to treat chronic pain and prevent migraines. Although originally developed for depression, it is now more commonly used off-label for pain management due to its effect on nerve signalling. It comes as tablets and as a liquid you swallow, both are only available on prescription[1]. 

You can find advice here on amitriptyline for depression.

What is amitriptyline used for?

Doctors may prescribe amitriptyline to treat[1]:

• Chronic nerve pain (neuropathic pain), including: 

  ○ Diabetic neuropathy 

  ○ Postherpetic neuralgia 

  ○ Sciatica 

• Chronic tension-type headaches prevention 

• Migraine prevention

How does amitriptyline work?

Amitriptyline affects how pain signals are processed in the nervous system[1]:

• Increases levels of serotonin and noradrenaline in the brain and spinal cord 

• Modulates pain signals in the central nervous system 

• Reduces the frequency and severity of migraines and chronic headaches

Who can take amitriptyline?

This medicine is appropriate for many people including[1]: 

• Adults (including the elderly, with caution) 

• Some children aged 2 and over for nerve pain under specialist advice only 

It may not be suitable for everyone, so speak to your doctor first if you[1]: 

• Have had a recent heart attack, heart rhythm problems or prolonged QT interval 

• Are taking monoamine oxidase inhibitors (MAOIs) 

• Have severe liver disease or kidney problems 

• Have ever taken medicines for depression, or have suicidal thoughts 

• Have glaucoma 

• Have type 1 or 2 diabetes 

• Have epilepsy 

• Are pregnant, trying to get pregnant, or breastfeeding 

• Are allergic to amitriptyline or its ingredients 

Please tell your doctor or pharmacist about any conditions you may have or medication you take before you start treatment, and always follow the instructions in the Patient Information Leaflet[2].

What is the typical dosage of amitriptyline?

Amitriptyline comes in three different strengths[1]: 

• tablets containing 10mg, 25mg or 50mg 

• liquid containing 10mg, 25mg or 50mg in a 5ml spoonful 

The starting dose for adults and children aged 12 to 17 is usually low and may be increased gradually[1]: 

• Starting dose: 10mg once daily, usually taken at night 

• May be increased to 20-30mg, and sometimes up to 75mg depending on response 

• For prevention of migraines, your doctor may recommend a higher dose 

The starting dose for children aged 11 and under depends on their weight and symptoms and will be decided by their doctor[1].

How do you take amitriptyline?

To use this medication effectively[1]:

• Take once daily, preferably 1-2 hours before bedtime as it can cause drowsiness 

• Swallow tablets whole with water 

• Can be taken with or without food 

• May take 2-4 weeks to feel full benefit

Can you stop taking amitriptyline?

No. Do not stop suddenly. Gradual tapering over several weeks is recommended to avoid withdrawal symptoms such as nausea, headache, irritability and sleep disturbances[1].

What do you do if you take too much amitriptyline?

Seek emergency medical help if you think you’ve taken too much. The symptoms of overdose may include[1]:

• Irregular heartbeat 

• Seizures 

• Confusion 

• Hallucinations 

• Coma

What do you do if you forget to take amitriptyline?

If you miss a dose[1]:

• Take it as soon as you remember 

• If it’s close to your next dose, skip the missed one 

• Do not double up 

• Be mindful that it can cause drowsiness if it is not at your usual dosing time

How do I store amitriptyline?

To store the tablets safely[1]:

• Store below 25°C 

• Keep in original packaging 

• Keep out of sight and reach of children 

• Do not use after the expiry date

What medicines can’t you take with amitriptyline?

Let your doctor or pharmacist know if you are taking any of the following[1][2]: 

• MAOIs (e.g. phenelzine, tranylcypromine) 

• SSRIs (e.g. fluoxetine, paroxetine) 

• Tramadol and opioids (risk of serotonin syndrome or breathing difficulties) 

• Anticholinergics (e.g. atropine) 

• Heart medications (e.g. beta-blockers, antiarrhythmics, centrally acting blood pressure medications) 

• Antifungals (e.g. fluconazole) 

• St John’s Wort 

• Alcohol (increases drowsiness and side effects) 

• Local and general anaesthetics and nasal decongestants 

• Thioridazine 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2].

What are the side effects of amitriptyline?

Possible side effects include both common and serious symptoms. The common side effects include[1]: 

• Drowsiness 

• Dry mouth 

• Constipation 

• Difficulty peeing (seek urgent medical advice if you can’t pee at all) 

• Dizziness 

• Headache 

Serious side effects include[1]: 

• Irregular heartbeat 

• Headaches, confusion or weakness as a sign of low sodium levels 

• Yellowing of skin or eyes as a sign of liver problems 

• Eye pain, redness, or changes in eyesight 

You should contact your GP if you experience any of these symptoms.  

If you experience any of the following call 999 immediately[1]:  

• Signs of a stroke such as weakness on one side of the body 

• Trouble speaking or thinking, loss of balance or blurred eyesight 

• You have a seizure you have severe chest pain 

• You have thoughts of harming yourself or ending your life 

In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

Symptoms of anaphylaxis include[1]:  

• Difficulty breathing  

• Tightness in throat and chest  

• Swelling of the tongue or throat  

• Feeling faint or dizzy  

• Blue/grey skin or lips  

• Loss of consciousness 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2].

Frequently asked questions about amitriptyline

How long does amitriptyline take to work? 
Sleep can improve straight away, but it can take 1 to 2 weeks for pain to improve and 4 to 6 weeks for the full effects to occur[1]. 

Can I take amitriptyline during the day? 
It’s best taken at night due to drowsiness[1]. 

Is amitriptyline addictive? 
Speak to your prescriber if you want to stop taking it as they can recommend a gradual withdrawal to prevent this[1]. 

Can I drink alcohol? 
It’s best avoided until you know how the medication is affecting you – it can increase drowsiness and side effects[1]. 

Can I drive while taking amitriptyline? 
Avoid driving until you know how it affects you. It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive[1]. 

Can I take it with paracetamol or ibuprofen? 
Yes but check with your doctor or pharmacist if taking long-term[1]. 

Does amitriptyline help with sleep? 
Yes, it can improve sleep in people with chronic pain[1]. 

Can I take amitriptyline during pregnancy or breastfeeding? 
It can be used during pregnancy and breastfeeding under medical supervision and if other treatments are not effective. There is no evidence that it is harmful to the baby or to breastfed infants. You should not sleep in the same bed as your baby if you are taking amitriptyline[1]. 

Can I take amitriptyline long-term? 
Yes, many people take it for months or years under supervision. Treatment should be regularly reviewed to ensure you are still deriving benefit from the medication[1]. 

For the official NHS guide to amitriptyline for pain and migraine, visit their website.

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