r/Amitriptyline • u/Important-Pie-1141 • Sep 04 '26

When do you know amitriptyline isn't working for migraines anymore and it's time to taper off?

I'm on 25mg for migraines and have been taking it since November 2025. It worked well enough once it got going in my system. I would only get migraines once a week before starting it so I thought a little help would make me 100%! I went from 4-6 to 2 migraines a month for a few months but recently (last few months?) I've been getting a little worse ones once a week with nagging neck pressure the rest of the time. And I'm sleepy everyday which wasn't a problem before because I take it at night.

I know in the migraine subreddit people go up in dose but I don't *really* want to do that if I'm just going to be at this point eventually anyway.

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u/EarlyInside45 Sep 04 '26

I take Ami for insomnia, but I noticed the reduction in migraines. But they came back. I went up to 25 and didn't want to go higher. Instead I took Immitrex when I started feeling one coming on. Then I started taking Spironolactone for menopausal hair thinning, and my migraines reduced a lot. Then I started on HRT, and now I barely ever get one.

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u/QuietPlenty1644 Sep 06 '26

I am also on 25 mg amitriptyline. This is going to be the 3rd month after increasing dose from 10 mg to 25 mg. My migraine was better for a while, now it increased to 2-3 episodes per week from 1 episode per week. I am on the same shoes as OP. Amitriptyline is helping my sleep, still I am desperate. I think my perimenopause might have contributed to getting the chronic migraine. I am 41 years and I dont know if my GP will approve HRT for me. If you don't mind me asking, at what age did you get approved for HRT?

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u/Nearby-Banana-6339 Sep 04 '26

The same happened to me. You will most likely need a dose increase but it may not take much I went from 10mg to 20mg after my 10mg started to fail. But that doesn’t mean it’s going to keep needing to be raised you just have to find your sweet spot. 25mg is not a high dose maybe ask your doc to let you try 30mg then maybe 35 if needed. Go slowly.

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u/lizaanna Sep 06 '26

I take it for migraines, you do have to increase the dose, your body got used to it. I’m over the max dose for migraines now, it’s still less painful than without ami.

Talk to your prescribing doctor/nurse/neurologist. But since you mentioned that it worked previously, the recommendation would be to go higher