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Amitriptyline v propranolol

The migraine treatments I’ve tried just don’t seem to be helping, I’ve had 13 days from the last 30 affected by migraine, and in most cases my attacks have continued on for hours without pain lessening after taking abortive medication. The only thing that seems to work is codeine which I obviously can’t take that often.
The next step I’m guessing is preventatives.
I’ve seen on here that the most common are amitriptyline and propranolol. I was wondering why one or the other of these is chosen, as well as other health considerations is it down to particular symptoms or just preference by the practitioner.

Current UK NHS Guidelines are: Propranolol, then Topiramate. As I cannot currently find a nice flowchart I want to use (probably as I’m getting sleepy) I attach the Scottish ones to give you some idea. Most UK GPs stick rigidly. Consultants more inclined to have preferences and do their own thing also have slightly more choice because a few drugs aren’t available to GPs. Your comorbidities (other conditions) and general health, age and amount of alertness your employment requires etc can all influence choice as can what success or otherwise the doctor has had previously. Particular symptoms don’t seem to count for much here in UK. Neither does whether its straight migraine or VM/MAV all treated the same. I should wait and see what’s suggested. Amitriptyline’s a good one to start with.;jsessionid=EC93B5680DCEC97447BC36F0D7A36B5C?pContentID=4492&p_applic=CCC&pElementID=578&pMenuID=464&

Thanks for that. I’m not really wanting to go onto daily meds at all. But cannot carry on as things are at the moment.

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If anybody’d had told me six years ago I’d end up taking beta-blockers I’m sure I’d have died laughing. Though it’s debatable how easy laughing would have been with curled teeth! Knowing all I now know I just wish I’d been offered preventatives 10/12 years ago whilst my condition was like yours episodic still because it is so much easier to get under control. Not wishing to spook you but untreated over time mine just got gradually worse and worse. Prompt medication improves recovery chances no end. Ask @Janb. Don’t worry about getting off the meds. Jump that stile when you get there besides, if hormones just happen to be involved in your case, getting off meds could be 5 years and more, end of menopause timescale away.


Great advice Helen!
I do think we all get very hung up on “getting off medication”. I was in great health and was a stereotypical “anti-pharma” person. I never thought I’d be on a daily medication. But here I am on a migraine preventative and not even thinking of when I will be free of it. I am allowing my Dr to be in charge of my condition… I have to. I tried by myself for a year; searching for the perfect supplements, vitamins, and herbs to no avail. I’ll be on the medication for as long as my Dr deems it necessary.


I completely understand how you feel about meds. I fought the battle against meds for almost 2 years and I did not win… Very similar to naejohn I tried everything in the book. It was an illogical fear within me but thankfully I found the courage to start daily meds, I’m now on a daily combo and I have no plans to come off it. I’ll face that step when I need to. Don’t worry about the future, focus on the here and now and get your quality of life back. Take one small step at a time but just keep on stepping. Best of luck jools in making your decision x


I really do think some people can fight it off with nothing more than a migraine diet and other lifestyle changes if started early on enough. Trouble is with ‘ladies of a certain age’ and indeed others whose MAV has strong hormone or metabolic links, They need something far more powerful.

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I love that on this chart the first choice for children (16+) is Pizotifen!

Sorry? The ‘lesser than’ symbol the arrow goes to the left, the ‘more than’ arrow points right.

Hi Jools
I too was afraid/reluctant to take daily meds but it became very clear very quickly that I couldn’t tame this beast on my own. I am on a combo of Venlafaxine (since July 2019) and Propanolol (Oct 2019) and I am starting to get my life back. This link below is to my neuro’s website and she gives a brief explanation as to how she thinks the most commonly prescribed drugs work for migraine.

Hope this helps

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which just goes to show how tough a nut MAV can be to crack. There’s nobody on earth gonna convince me not eating a banana with my lunch or avoiding cheese is going to stop my case either. Drastic conditions call for drastic measures. I’d encourage anybody episodic to start treatment now before it has a chance to become chronic, because I certainly would have loved the opportunity.