Nortriptyline or SSRI's for MAV?

Which one do you really think works BEST for MAV dizziness? I just read Heel your Headache and he states that SSRI’s DO NOT work, but the Dr. loves nortriptyline. Dr. Baloh and others believe that ssri’s DO work! Whats the deal? On this site there seems to be a lot of people on nortriptyline and getting good results on it. Have any of these people first tried an SSRI instead? I will keep taking the Celexa and hope for it to kick in but I am wondering if I am just spinning my wheels and should get on something that actually is For Migraines. Thank all!

Joliview-- My guess is that if stress and anxiety are the main trigger for your migraine, then ssri would be beneficial cause of the seratonin it targets. But on the flipside, Nort targets some other brain chemicals including seratonin. But I don’t think it hits seratonin as well as ssri does, so it may take longer for nortriptyline to work. SSRI may act as a quicker recovery if anxiety/stress is your main trigger. I could be wrong though. That’s just my guess. It makes sense to me.

I know amy on here had great success with Nortriptyline.


Well Celexa did work well for me, although I did still feel off quite a bit, so it didn’t take me to 100%, probably 80%. I went off due to weight gain and feeling better (or so I thought) and the dizzies came back. Thought it was anxiety so they put me on Prozac since I didn’t want to do Celexa again. I’m 5 weeks in and at 15 mg so we’ll see how it goes. I think it’s helped a bit, but anxiety is still high. I remember that with Celexa though, it took several weeks to kick in, and I had increased anxiety the entire time.

My neurologist told me last week that there is literature supporting Prozac and Effexor as anti-migraine, so while they’re as good as nortriptyline, they do work for some people. He did say that nortriptyline is better. I think a lot of people here have said that it just depends on each person. I’m going to try adding propranolol again if the Prozac doesn’t do the trick, and then taper of Prozac. Then maybe I’ll try nortriptyline if that doesn’t work.

edited to add–I was surprised that he said literature supports Prozac, as everything I’ve read says it can be a migraine inducer so I was worried I was on the wrong drug. I’m going to give it a few more weeks and see what happens.

Hi, maybe we just don’t give the meds time to work. You mentioned that it took a while to see results on Celexa. I have been on it before but gave up after 4-5 weeks because I wasn’t seeing enough results. Maybe I should have stayed on it longer. Its so hard because we all want and NEED to get better NOW!!

It seems every Doc has their favorite med for migraine…for many, Nortriptyline is a fave…for others, Celexa and Effexor seems to be favored. AT the end of the day, it is some brain chemical(s) amiss in your particular case and the mystery is figuring out which one or ones it is. Nort hits both sero and norepinephrine, so you are getting 2 chemicals…better shot at the odds there…Mayo Clinic says that Effexor is showing “robust” signs of helping migraineurs…at higher doses, it kicks in to hitting sero and NE as well…
Cymbalta, which I am on , hits both of these neurotransmitters at more or less equal amounts. The others don’t…efficacy for anxiety is the same as effexor, but supposedly better in the long run than the SSRI’s…(at anxiety remision)…

my personal experience with psychiatrists is that if a drug doesn’t work at least a little in the beginning, it’s not hitting the right transmitter…if it helps, and then stops, you’re in the right category os meds, but need to try a different one…if it sucks and keeps getting worse…move on…
My sister started Remeron and loved it from day 1…her husband started Celexa and she saw a positive difference in him the next day…I tried Remeron and was noticing I was getting better the very next day…not cured, but better…


Joli I’d definitely give it a good 6 weeks to see if it’s making any kind of improvement. I think it may have been at week 8 that I was finally noticed “hey, I’m not dizzy all day long!” In fact, I remember one week after bumping up to 20 mg (the minimum therapeutic dose) that I had the worst dizziness, anxiety and crying spell. It was another week until I noticed that the dizzies were gradually subsiding, and the anxiety dipped way down.

I’m struggling right now with increased anxiety on the Prozac, and not sure if it’s really decreasing the dizziness or not. I’ve also been taking magnesium and b2 for the past 4 weeks, and will try a compounded capsule my neurologist recommends with feverfew and buttbur in addition to the mag & b2. I’d like to give that a shot before adding another med, likely a beta-blocker.

WOW thats an eye opener! I thought most people got better right away on the right medication, I didn’t realize it was so up on down until relief hits! Thanks Anne for your insight!

How long have you been on the Celexa?

i was on it for around 5 weeks t only 10 mg and then I gave up. I just recently restarted it and have been on it for 2 weeks. This time I am going to try to stick it out and get up to a more therapeutic dose.

Nori did work well for me. Before that I had tried propanolol, topamax and verapamil but the nori was the only one I could tolerate. It took a few weeks to work and took about two months before I felt the full effects but it did work well when I was on it. I have never been on an SSRI. I have a bottle of effexor ready in case I feel dizzy again but so far I have not felt badly enough to try it.

Hi Amy, I think you are probably not on this forum anymore, but if you do check your messages, I’d love to find out whether you were able to come of nort. after being on it at the dose you mentioned of 30mg. I have a friend who used 30mg to get control of her MAV, and she’s trying to get off of it - which sounds like the goal after you control your symptoms at whatever dose (to come off it slowly) but we don’t know whether that will work. I am also asking for myself because I am very curious (and hopeful!) that if I went back on nort. slowly and used it to control the MAV, I might be able to get off of it if it changed my brain enough out of the migraine state. Hope to hear from you! Liv

Did the nort give you fast heart rate or palpitations? Any bad side effects?

No palpitations thankfully (no irregularities) but a bit faster heart beat but it seems to be something does does go away for people once they are on the drug a little while and adjust…that’s what fussy fussy said about her experience with it. It’s not one of the most annoying side effects I’ve experienced overall w/ drugs…so I’d take that one over others.

Hi Liv.
Just to clarify, I would especially be out of breath when going up the stairs at home and my heart rate would hover around 90’s for a while while sitting down as I went up the Nort. But over time it settled. However, this seems to happen to me when I have a cold and my MAV is worse, etc as well, so I never worried about it when it happened with Nort. dose increases. Just wanted to clarify that in my case it was nothing alarming.
Having said that, pls do judge based on how you feel while on it, if you try it again. Also, I am telling you, if you worry that your heart rate will go up, it will. So try to be calm.

Hi…I took nortripyline and it didn’t work for me Was only takin 30 mg…now I am taking depaloe and 100mg of gabapentin…These meds are not good for you…although it helped me I am still getting dizzy…started depakoe late Sept and Gabapentin mid JUly 2015…I tapered down to 100 now…Will MAV ever go away??? You know Janet Jackson had this and they say shes fine now

Hi there,

I’m almost 100% recovered with 100mg gaba 3x a day, and 400mg magnesium glycinate, 400mg B2, and 400mg CoQ10 - I can’t drink coffee though. That is my main trigger along with MSG for head pressure. I drink wine without a problem again and can eat almost any foods.

Janet Jackson indeed is supposed to have had vestibular migraine - I really wish she’d publicized that more and about her way of recovering too for other people who have had experienced it. It is probably the most challenging thing I can imagine, but I feel like we’re somehow special for having to get stronger to get through it and learning about the importance of life priorities and our health because of it.

At least that’s what I tell myself! :smile:

Best wishes for your recovery. I’d recommend the supplements (I take the KAL brand of magnesium) the most of all. I can almost not take the gaba if I don’t want to and still be OK. I kind of take the gaba as an insurance policy! :wink:


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I think you have to give things long enough to see if they work for you. I’m on nortriptyline, have been since July last year, now at 35 mg. I have to increase 10 mg every 4-6 weeks until I stabilise or reach 75-80 mg. My doc won’t try anything else until this route has been exhausted. I think you need to give options the time they need to take effect. There don’t seem to be any quick fixes. My doctor said it has taken a long time for our brains to get into this mess and it will take a long time to calm it all down. It’s horrible but the mental battle is half the struggle for me. I try to just accept this is the way things are for now (easier said than done)but I know getting stressed out doesn’t help me. I know I’ve improved significantly if I cast my mind back a year, and have to keep telling myself I’ll get all the way there! Try to be positive.

I agree with what Scottl said 100%. You will improve on something - you just have to find the medicine you can tolerate and that helps you. I’ve found I can only tolerate low doses of drugs since I seem to metabolize them efficiently and therefore suffer more side effects but also benefit from a lower dose than most people… The supplements I mentioned also help. I try to avoid gluten and inflammatory foods and caffeine. A glass of wine or beer on gabapentin at the low dose I’m on doesn’t seem that problematic. Stay strong. xx

Hey Scottl.

I have a question for you. You said the your doctor said it took a long time for our brains to get into this mess, so it’ll take a while to heal from it. I haven’t heard chronic migraine alone being characterized as a " big mess". Does your doctor refer to it as such because the dizziness/vertigo component shows that we are in a bigger mess? In other words does the fact that we developed dizziness with this mean that our brains are really messed up, more than they would have been if we just had the daily headache type migraines instead?

Thank you!

Hi fussy
Yes I think so. He says my brain (or ours) is in a highly irritated state, so it has taken a long time to get so irritated and will take a long time to calm down. I’m pretty sure he’s simplifying things considerably! So I think our brains are in a constant irritated state and people who have classic migraines from time to time, have flare ups. That’s how I took it anyway, someone else may know better.

My doctor constantly refers to my irritated brain! So I’m imagining the blood vessels are inflamed? And does this cause the misfiring of electrical signals? If someone understands exactly what is going on it would be good to know!