100 Migraine Drugs, A to Z: desipramine

Desipramine (Norpramin) belongs to the family of tricyclic antidepressants which have been proven to be effective for the treatment of various pain syndromes and for the prevention of migraine headaches. Desipramine is used much less frequently for migraines than amitriptyline (Elavil) or nortriptyline (Pamelor) and there are no controlled trials of this drug for the prevention of migraines. However, it has been proven to be as effective in relieving pain of diabetic neuropathy as amitriptyline. It was also shown to be effective for the treatment of postherpetic neuralgia (shingles pain) and chronic low back pain.

Desipramine has the advantage of being less sedating than the more popular tricyclic antidepressants and causing fewer other side effects, such as dry mouth and constipation. In one study desipramine caused less weight gain than amitriptyline (but as much as nortriptyline). It is dosed similarly – it is started with 10 or 25 mg and the dose is gradually increased as needed and as tolerated. The average dose for the treatment of pain is between 25 and 75 mg, while for depression it can go up to 150 mg.

All tricyclic antidepressants can cause cardiac arrhythmias, especially at high doses and an electrocardiogram is indicated in those with heart disease or multiple risk factors for heart disease. We tend to avoid it in the elderly also because of the increase in the risk of falls due to sedation, as well as constipation. Tricyclics can lower seizure threshold and should be avoided in people with epilepsy.