Treatment Plan
Infrequent:
- Self-limiting
- Simple analgesia
- Treat associated neck pain/sleep issues
Frequent/Chronic:
- Acupuncture
- CBT
- Exercise
- Physiotherapy
- Relaxation techniques
- Amitriptyline prophylaxis
- Avoid acute medications (risk of medication overuse headache)
Amitriptyline contraindications:
- Heart block
- Previous MI
- Recent MI
- Symptoms of mania in bipolar
Amitriptyline side effects:
- Increased heart rate
- Prolonged QT
- Palpitations
- Heart block
- Mydriasis
- Blurred vision
- Speech disorders
- Aggression
- Dyslipidaemia
- Erectile dysfunction
Drug interactions:
- Avoid medications prolonging QT:
Antiarrhythmics, antipsychotics, antidepressants, domperidone, sotalol, erythromycin