I've heard of it being increased to find the right therapeutic dosage (called titrating) but over time can indicate a development of tolerance. How much was he originally prescribed, and how much are they increasing it to? (I've heard of 10, 20 & 30 mg for migraine).

There may be more info available by googling: amitriptyline for migraine

If you're looking for alternatives to discuss with his doctor, try the searches I mentioned previously.

Doc

Thanks Doc. Yes, I googled some of your earlier searches and found them helpful. Sorry, I had thought I responded to that post, but see I did not. We are going to a headache specialist next month. The current neurologist doesn't seem to think outside the box. We are not experiencing cookie cutter symptoms here and we are becoming frustrated.

My gut is telling me the amitriptyline is not giving him relief and not knowing if the amitriptyline is actually helping, or not, we are struggling with upping the dose, or weaning. We started with 10 mg and increased by that amount until we reached at 50 mg. He never actually had relief until the cyproheptadine was added, but then it was stopped fairly soon and the headaches returned. They now want to increase the amitriptyline to 75 mg.

The side effects from the amitriptyline are starting to wear on him and we do not want to increase this med...especially not knowing if it's actually helping or not. Thanks for your help. I'm just looking for some answers and/or possibilities to take to the headache doc.

that cypro is a antihistamine for allergys ... how does that headaches ??

here are the symptoms of Chiari malformation and the only way to find out is by Cervical MRI . have just your family dr order one . and then you will know

http://chiaricare.com/Chiari-1-Malfo.../Symptoms.aspx

I will definitely check out the link and add this to my list of items to ask about. Thank you. Can you have Chiari with a normal lumbar puncture pressure?

As far as the cypro, its used for migraine in pediatrics. I thought the same thing but it worked great. The only problem for him is drowsiness. It also increases appetite, but he needed to gain a little, so that wasn't an issue.

I can relate to that. Early on in my migraine journey, my PCP had to enter something in his computer as to the type of migraines I had. He apologized for being slow about it (not that I even noticed), remarking, "They have 22 different classifications of migraine in here, and none for 'other' and that's what you have. ...Oh, there it is."

Googling: amitriptyline migraine dosage I found:
and a study indicating increasing dosages may not be more effective, and more. I did not spend a lot of time perusing but it appears there are some worthwhile articles in that search.

The high doses of amitriptyline surprised me. In my own experiences with it, 10 mg is enough to lay me out for a day and a half. I may have an unusual sensitivity to this medication.

Personally, I'm not keen on using it for an adolescent for any reason because of the black box warning and associated side effects. OTOH, no parent wants to see their offspring suffer these blasted things.

I hope you have better success with the headache specialist.

Not for nothing, but how is your son's posture? Does he spend a lot of time at a computer?

Doc

Thanks Doc. Those were wonderful links and I spent a great deal of time reading through them today. If anything I think they may have convinced me he needs to come off of it and we need to try something else. If it was working great, it would be an easier decision. However, it's not working well at all and I'm not so sure it's worth the risk to keep upping the dose and then have to worry about getting him off it at a later time. The withdrawals from this sound difficult. Granted, there's not too many good news stories on the internet and difficulties run rampant, but he's so young...I'm more petrified to keep him on it in light of how he's feeling.

BTW, he's not a big computer buff, but I understand your concern. He has spent all summer at PT and, believe me, he pays attention to his posture more than any kid I know! :)

Thanks a ton for your well wishes, suggestions and links. It's greatly appreciated.