Aug. 23, 2000 -- An antidepressant to prevent headaches? Absolutely! A new study shows that taking the antidepressant Elavil (amitriptyline) every day can help reduce the frequency, severity, and duration of pain in children who suffer from headaches regularly.
According to Andrew D. Hershey, MD, PhD, who conducted the study, headaches in children are "a very common problem that often goes unrecognized because of a variety of factors. One of them is that parents and teachers don't believe kids when they say they have headaches. ... There's also a misunderstanding that [when] kids have headaches, they should just sleep it off and not take medication for it."
Hershey says that an estimated 10% of children aged five to 15 and possibly as many as one-quarter of those aged 15-19 suffer from recurrent headaches, including migraines, which are a very severe form of headache often associated with nausea, vomiting, and disturbances in vision or other senses. He estimates that a third to a half of these children experience headaches more than three to four times a month, which makes them good candidates for preventive therapy like Elavil.
Hershey and his team at the Headache Center of the Children's Hospital Medical Center in Cincinnati treated 146 children who suffered from more than three headaches a month with daily doses of Elavil. Most of these children had migraine headaches, but a few had tension or other headaches.
After about one to three months on Elavil, 84% of the children reported feeling better. They experienced improvement in the frequency, severity, and duration of their headaches and were less likely than before treatment to miss school.
Most patients in the study, published in the July issue of Headache, did not find the side effects of the drug to be bothersome, but Elavil is not without some adverse effects. It can cause constipation, dry mouth, and blurred vision quite commonly in children, although these usually disappear gradually with continued use of the drug.
Headache expert Seymour Diamond, MD, is a big believer in Elavil and similar drugs (called tricyclic antidepressants) for the treatment of recurring headaches in both children and adults. He says that taking Elavil daily in doses much lower than those used to treat depression can often greatly improve and sometimes eliminate recurrent headaches.
Many over-the-counter painkillers, like aspirin and Tylenol, cause worsening of headaches when used too often, whereas Elavil does not. Over-the-counter pain relievers should be reserved for occasional headache sufferers, while those who experience several severe headaches each month should consult a physician about a preventive therapy, says Diamond. He is director of the Diamond Headache Center in Chicago, executive chairman of the National Headache Foundation, and author of the upcoming book entitled Headache and Your Child.
There are also other prescription drugs that can be taken every day by children to help prevent headaches. Periactin (cyproheptadine), an antihistamine, and Depakote (divalproex sodium), which is normally used to stop the seizures associated with epilepsy, can help.
Physicians select the appropriate medication based on the needs of the individual child. For instance, Elavil is sedating, making it a good choice for children whose sleep is disturbed, and Periactin is not appropriate for heavier children, as it can stimulate the appetite.
Hershey advises parents of children who often suffer from headaches to point the condition out to their pediatrician. He says not to wait for the pediatrician to raise the subject first, as doctors often do not think to ask about headaches in children. However, when they are alerted to the problem, they do have solutions to offer.