Review: Nortriptyline as a Migraine Prevention

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November 1, 2007

So I decided a few months ago to gradually wean myself off of Nortriptyline, the drug which started out on the market as an antidepressant, later to be used as a migraine preventative. I’ve been taking these little green and white pills for about a year and a half, and I gotta say, the number of full-force migraines that I’ve had was substantially lowered even at just a 20mg dose. The side effects where somewhat annoying, like sweet tooth cravings, and the typical antidepressant factors.

My biggest (only?) beef with this wonder drug was that it made me scared to stop taking it. I worried I’d start getting slammed again with the same old weekly stack of 3 to 4 migraine whoppers that would creep up out of nowhere. Looking back, it might have been the stress of a long commute and other factors in my work/business life, as well as my general health not being what it should.

In the investigation of why I’m getting the migraines, my primary care physician pondered a few months after starting me on Nortriptyline whether allergies or other sinus issues played a role in my migraines, and sent me to an allergist literally down the walkway from his own office. Her conclusion was that I suffered from chronic non-specific sinusitis, and that Nortriptyline would interfere with a skin allergy test so they’d have to take a blood sample to run the tests.

Funny enough, wouldn’t know you know my allergy test came back saying I had zero allergies? Zero. None. Which baffled me because I know for a fact that I have an allergy to feathers and dust – it was clearly diagnosed and confirmed by two separate doctors in Ottawa back in 19992000 before I moved to Los Angeles, and proven true during a pillow fight with my wife in 2005 – she bopped me with her feather pillow and I was stuffed up for 3 days… Yet suddenly in early 2007 I don’t have allergies anymore? Oh, but here’s THREE other medications to take (two pills and an inhaler) that all treat allergic symptoms, but I DON’T have any allergies. Yeah, whatever, you quack: I turned on the window fan in our bedroom two nights ago, got a face full of dust, and couldn’t breathe clearly for over half an hour, but yeah I don’t have allergies…

So to help pinpoint things with a more accurate allergy test, I decided to gradually lower my dosage of Nortriptyline over a period of about two months, which meant instead of two 10mg pills at night, that I’d only take one for a few weeks, then I’d take one every other night, every three nights, etc. I still have about a half dozen pills should I feel the need.

However, lately I’ve been facing another pending health issue since stopping the Nortriptyline.

After reading the fine print, the instructions to take Nortriptyline at night were written because the pills have a slight sedative effect. Which, as you can guess, means I’m not longer getting my full 8 hours of sleep at night.

Okay, okay, I’m not getting my typical 5-6 hours of sleep at night. Somehow, I’ve been surviving on about 4 hours or less of sleep every night for the past month or so, occasionally sleeping in on Saturday mornings, my only day to sleep in.

Since weaning myself off of Nortriptyline, besides not sleeping as well, Elizabeth says I’m snoring more than usual, my thoughts aren’t as focused, and thank heavens I’m not driving a 2-hour commute in each direction on barely any sleep. The good news though is that in the past two months while weaning myself from the drug, I’ve only had two migraines, and while on Nortriptyline I’d get one bad one about every 2 months. One knocked me out on a Sunday afternoon, the other was early last week (or the week before, I forget) and kept me up almost all night.

So of course I’m curious how long I should wait before going back in for a skin allergy test. I’m sure Nortriptyline lingers in the body for a while. My stress levels have obviously lowered quite a bit since working from home again, but I’ve been promising more and more freelance work to side clients other than my primary contract, so I need to be careful that I don’t burn myself out, especially given the history of some of my clients having lots of work to do to revamp their web sites for the new year.

I’m hoping that the insomnia wears off soon. I hate taking medication to fall asleep, due to a weird fear of addiction. Not that I’ve ever been addicted to anything other than caffeine… but still. My mind now ponders the potential reality of having to deal with both migraines and insomnia at the same time, and which would be the lesser of the two evils to combat.