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Nortriptyline is an active metabolite of amitriptyline by demethylation in the liver. Chemically, it is a secondary amine dibenzocycloheptene and pharmacologically it is classed as a first-generation antidepressant. [36] Nortriptyline may also have a sleep-improving effect due to antagonism of the H 1 and 5-HT 2A receptors. [37]
Amitriptyline is probably effective for the prevention of periodic migraine in adults. Amitriptyline is similar in efficacy to venlafaxine and topiramate but carries a higher burden of adverse effects than topiramate. [16] For many patients, even very small doses of amitriptyline are helpful, which may allow for minimization of side effects. [38]
Rescue treatment involves acute symptomatic control with medication. [4] Recommendations for rescue therapy of migraine include: (1) migraine-specific agents such as triptans, CGRP antagonists, or ditans for patients with severe headaches or for headaches that respond poorly to analgesics, (2) non-oral (typically nasal or injection) route of administration for patients with vomiting, (3) avoid ...
These are medications or devices you can use during a migraine attack to help stop symptoms like pain and nausea. “We do not use opioids for migraine management because they can make migraines ...
Amitriptyline has been more frequently studied of the antidepressants and is the only antidepressant with fairly consistent support for efficacy in migraine prevention [citation needed]. The method of headache prevention with antidepressants is uncertain, but does not result from treating masked depression .
The triptan drug class includes 1st generation sumatriptan (which has poor bioavailability), and second generation zolmitriptan. [2] Due to their safety, efficacy and selectivity, triptans are considered first line agents for abortion of migraines. [2]
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