AMITRIPTYLINE

What is amitriptyline (Elavil, Vanatrip)?

Amitriptyline belongs to the class of medications called tricyclic antidepressants. Mostly used for depression, it is normally prescribed as an alternative when other depression medications are not effective. Amitriptyline works by inhibiting the reuptake of the neurotransmitters norepinephrine and serotonin. By preventing the breakdown of norepinephrine and serotonin, it aids in restoring the imbalance of these chemicals caused by depression.

What is the link between amitriptyline and long COVID?

Many patients diagnosed with long COVID are plagued by moderate to severe, frequent headaches. The cause is thought to be massive inflammation accompanied by a cytokine storm (overexaggeration of the immune system) [1]. These headaches can worsen a preexisting primary headache or, more specifically, present as a new (intermittent or daily) headache starting during the acute infection or after a delay [1].

To treat these headaches, providers have turned to amitriptyline as a potential treatment option. One observational study looked at post-COVID patients treated with amitriptyline and found that using amitriptyline reduced the number of headache days per month by 9.6 [2]. Additional case reports found amitriptyline was helpful in patients with long-lasting COVID headache and chronic migraines post-COVID. However, the patients in these case reports did not use amitriptyline as a single agent; it was combined with Botox injections [3].

Although amitriptyline will not cure long COVID, it may offer symptom management in headache sufferers. Additional research may help to solidify amitriptyline’s use in long-COVID treatment.

References:

¹https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-022-01450-8

²https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553757/#:~:text=Conclusions,TTH%20and%20without%20concomitant%20nausea.

³ https://americanheadachesociety.org/news/research-summary-toward-a-better-understanding-of-persistent-headache-after-mild-covid-19-three-migraine-like-yet-distinct-scenarios/