Comparison of Venlafaxine and Amitriptyline

i did a little more digging into this. believe it or not, there are no clinical trials of amitriptyline in VM/MAV specifically (https://academic.oup.com/brain/article/145/11/3741/6647603), only small retrospective studies. the only reason its even used in VM is because that clinical knowledge was extrapolated from the understanding of how the drug works in classical migraine. similarly, the side effect profile must also be extrapolated. surely, if we cannot extrapolate knowledge from classical migraine to vestibular migraine in order to have clinicians make better informed decisions, then according to your logic, there is no evidence for the use of these drugs at all! in fact, even these small retrospective trials involving tricyclics make note of a high rate of side effects in patients, despite the doses used (for vestibular migraine specifically).

Even Dr. Hain himself says to expect significant side effects with tricyclic medications, despite still recommending their use along side venlafaxine as first-line options. Venlafaxine for Migraine Headache

You cannot in good faith say that the side effect profile for tricyclics is different in VM patients is different from classical migraine patients without literature to back it up. a responsible clinician must use knowledge of the side effect profile from classical migraine in their treatment of vestibular migraine, because thatā€™s where most of our foundational understanding of the disorder arises. even with all that in mind, there is evidence (of the same quality that tricyclics can be used for VM) that their use in vestibular migraine specifically can result in a higher rate of side effects. of course, most patients donā€™t care ā€“ they just want to get better! But for 2 drugs with similar efficacy, it makes sense that doctors as they learn more would like to start with venlafaxine, and then if that doesnā€™t work, thereā€™s always the very effective tricyclic branch to reach out to. i think thatā€™s why we see that trend emerging among neurologists and neurotologists, especially as more evidence mounts for the use of SNRIs in migraine.

all this is not to say that side effects with ami or nort are guaranteed; they just have a higher probability of side effects

again, i personally would have rather started on nort, but I understand and accept this line of reasoning from the physicians.

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From a purely personal, anecdotal and therefore unscientific point of view I tried both Amytriptyline and Nortriptyline, both because of the good reviews Iā€™d seen on here and elsewhere and secondly because in the UK they are one of only 3 drugs that primary care GPā€™s can prescribe for migraine prevention. The others being Propranolol and Topamax.

In both cases they caused me to feel very shaky, with very fast heart rate and palpitations. With Nortiptyline, which was a little easier to tolerate I also had daily headaches. So I got to 30mg on Nort, was feeling no improvement in symptoms, so decided to come off of it. I trialled Candestarten which was ineffective, then decided to take the plunge with Venlafaxine, which Iā€™m tolerating really well.

I think it just shows how different we all are and why its a good job there are so many treatment options open to us.

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thanks a lot for digging, and agree with your points. Lots of open questions, huh? But at least we can trial these things for ourselves with the cooperation of a trusted doctor.

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There is a FB support group that literally thousands of people have posted about the devastating issues they had while taking Effexor. The group is called Effexor Support Group. Many of us whoā€™ve used this drug - I used it for VM - believe it should be pulled off the market. My issues began when I started getting withdrawal symptoms, brain zaps and Gaze Evoked Tinnitus, when I had not missed a dose. Effexor is notorious for withdrawal symptoms when only one dose is missed because of its very short half life. But when not missing a dose? I discovered by joining the support group that others had the same experience, Doctors up the dose when that happens and then youā€™re trapped. In other words, Effexor is habit forming, And the more you take, the worse the symptoms. I know people who took a year to get off. It took me 4 months. Itā€™s poison as far as Iā€™m concerned.

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Sorry you had such a bad experience with venlafaxine. As I stated on the other thread, there are plenty of horror stories and reports of Effexor having unpleasant side effects. Effexor seems to have a distribution of side effects thatā€™s relatively minor in most situations, but an appreciable density in the unfavorable side of the curve as well.

However, just because you had a bad experience with the med does not mean it does not have substantial clinical utility. Do a search for Reglan on Facebook and youā€™ll find support groups of similar people with bad experiences regarding an otherwise widely used drug.

We all have different physiology and respond to medications in different ways, but calling something ā€œpoisonā€ seems exaggerated.

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I had the exact same reaction to nortriptyline. I tried it 3 times - and each time experienced significant tachycardia. Fortunately, I had a good doctor at the time that paid close attention to side effects and knew what to look for. I had pinned a lot of hope on that drug (Dr. Rauchā€™s favorite) - which is why I retested it twice.

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My brother had a similar experience with an SSRI (Paxil). When he tried to get off of it, he got bad vertigo, so stayed on. Recently, he increased the dose due to some anxiety he has been experiencing.

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Does Venlafaxine help with screen intolerance/sensitivity?

Tomorrow it will be three weeks since I started Venlafaxine (75mg) with a quarter pill. After two weeks were up and my body seemed adjusted to the quarter pill, I started increasing every 3 to 4 days to 1 day of half pill. Hesitant to increase to half every day, I thought trying to increase to half every third day might help me slowly go up on it. The other days still taking a quarter pill. Slowly Iā€™m hoping to alternate between quarter pill and half pill until I can be on at least half pill daily (37.5mg). From there in baby steps try to get myself on the full 75mg pill.
However I feel quite sick when I go on my laptop and on my cell phone and Iā€™m wondering if Venlafaxine will help with that? When I was on the Ami/Nori, it definitely eased my screen intolerance. However since Iā€™m off the Nort, I would like to know, those of you who suffer from screen sensitivity, if you have noticed any difference?
I really really want this to work. It seems Ven is the medicine for VM and Migraine Prevention. I suffer from both as I have triggers of motion, sound, smell, screen, stress, driving, fatigue, you name it. I am struggling so much to feel well, and putting a lot of hope in this drug. I could not find a topic for this so Iā€™m posing this question in my diary. Would be very appreciative of any feedback, observations etc.
Thanks so much! Healing vibes to all.

Yes; venlafaxine is a good med for visually-induced vertigo/dizziness and is often prescribed as such. Hain describes that visual sensitivity is an indicator for successful use of venlafaxine.

Youā€™re taking far too little of a dose to try to assess whether or not this is going to work ā€“ 75 mg seems to be the new minimum so far whatā€™s effective for VM, and my own neurologist has said that 150 mg is his average dose for VM patients and the one that they have the most success on. Of course there will always be patients that need more and need less but the central tendancy is ~150mg from what Iā€™ve heard.

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I think Amitriptyline is likely more effective for screen intolerance as it is a vestibular suppressant. Afaia Venlafaxine is not?

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Thank you @sheepdog_lord
Your feedback is very helpful to me. Iā€™m now considering increasing the Ven to half pill every other day and continue the quarter the other days. I was hesitant to increase this week as Iā€™m due to travel next week. Yesterday I had a horridly nauseous day and I just couldnā€™t figure out the possible reason. But Iā€™m really hoping that by increasing it to half every third day last week maybe my body will be able handle the half every other day now while still doing the quarter pill on the other days. (I know it sounds confusing, but you get what Iā€™m saying??)

Starting the Venlafaxine with the quarter pill for the first time was incredibly trying- it took 12 days to get out of the sick feeling. I just keep pushing myself and keep fingers crossed along with my daily prayers that it will workā€¦oh how much I want this to work!

Yes, the visual induced sickness I get from going on my laptop and cell phone leaves me feeling sick and uneasy. Yes, Ami/Nori did help with screen intolerance but when it no longer helped daily headaches I asked to try another medicine.
Thank you to all who respond.

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possibly ā€“ just read that from Hainā€™s blog

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you dont have to uptaper any faster (unless your doctor thinks its a good idea). Go as slow as you have to but expect to need higher doses than 37.5 mg for any kind of significant relief

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I too felt that Ami and Nori helped with that. However the daily headaches are a pain and I felt Nori stopped helping with that part. Iā€™m also on Emgality monthly. I should try a med that would help me with both the migraine part and the irritability/angst part. Our mood is a big part of this horrible condition and somehow needed to feel less anxious and more calm. Iā€™m really hoping Venlafaxine can help wtih both on top of Emgality.

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Yes. My doctor just wrote for the 75mg Ven and left it to me to figure out how to go about using it.
Iā€™m glad I started with a quarter pill each day and gave my body the time to adjust initially.

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2 posts were merged into an existing topic: Effexor looking for some advice

Can you please link that?

A post was merged into an existing topic: Effexor looking for some advice

letā€™s stick to a comparison discussion here, post elsewhere for specific venlafaxine advice.

see Hainā€™s page on venlafaxine, particularly the section where he discusses his preference for it in use of visual dependence

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