notes (if applicable):
|Why this is important:- Effective prevention has the potential to make a major impact on the burden of disability caused by recurrent migraine. There are few pharmacological agents that have been proven to prevent recurrent migraine.
Amitriptyline is widely used, off-label, to treat chronic painful disorders, including migraine. Inadequate evidence was found in the review for this guideline for the effectiveness of amitriptyline in the prophylaxis of migraine. A double-blind randomised controlled trial (RCT) is needed to assess the clinical and cost effectiveness of amitriptyline compared with placebo. The definition of migraine used should be that in the International classification of headache disorders II or this guideline. Outcomes should include change in patient-reported headache days, responder rate and incidence of serious adverse events. If amitriptyline is shown to be effective, it will widen the range of therapeutic options, in particular for people in whom recommended medications are ineffective or not tolerated.