100 Migraine Drugs, A to Z: Doxepine

Doxepin (Sinequan) is a tricyclic antidepressant and all drugs in this category (amitriptyline, nortriptyline, desipramine, protriptyline) appear to be effective for the prevention of migraine headaches.

Only a single small trial of doxepin was conducted in patients with chronic migraines. However, it is very likely that it is as effective as other antidepressants. Doxepin is one of the more sedating tricyclics and is more often used for insomnia than depression or migraines. A typical starting dose of doxepin is 10 mg. The dose is increased to 25-75 mg for migraines and up to 150 mg for depression. For sleep, even 3 or 6 mg dose can be sufficient and such doses in a branded product, Silenor are approved by the FDA for insomnia. Branded products are usually very expensive and Silenor is no exception – $15 a pill, while 10 mg of doxepin is $.50.

Side effects of doxepin are similar to those with other tricyclics – daytime drowsiness, even if taken only at night, dizziness, dry mouth, constipation, weight gain, and other. These side effects is what limits the usefulness of this category of effective migraine drugs.