Traumatic Brain Injury and Post Concussion Syndrome For traumatic brain injury (TBI) and post concussion syndrome (PCS).


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Old 06-21-2013, 01:17 PM #1
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Default Thinking of switching to Amytriptyline

Cymbalta has served me very well in my recovery, and without it I would not be where I am today.

However I have been working harder and getting headaches and fatigue more frequently, as well as tired/sore eyes. I have a frequent low level dull headache, even at weekends.

The only time my head feels truely normal is when I take Imagran (Sumatriptan) but this is limited to 6 tablets a month.

Cymbalta helps with mood, reducing symptoms and neuropathic pain. However I read that the most effective migraine preventative from clinical trials is Amytriptyline.

Part of me thinks I don't want to rock the boat, but another thinks I need more effective headache prevention. I have 14 x 10mg tablets in the cupboard.

What do others think?
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PCS following head injury November 2012. Experienced dizzyness, light and noise sensitivity, hypercusis, fatigue, insomnia, migraines, facial pain, problems concentrating, irritability, sensory overload, exercise intolerance.

Symptoms mostly resolved, working full time and I am now mostly better. I wake 6am daily since my injury. Was experiencing daily Neuralgia which was controlled with Cymbalta 30mg, Lyrica 200mg daily. Now only on 30mg Cymbalta.
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Old 06-21-2013, 02:43 PM #2
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After discussing with my wife I decided to double the Cymbalta dose to 60mg, one 30mg am and pm and see how I get on because it is a medication that mostly agrees with me. Will let my doctor know next week if it is working.
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PCS following head injury November 2012. Experienced dizzyness, light and noise sensitivity, hypercusis, fatigue, insomnia, migraines, facial pain, problems concentrating, irritability, sensory overload, exercise intolerance.

Symptoms mostly resolved, working full time and I am now mostly better. I wake 6am daily since my injury. Was experiencing daily Neuralgia which was controlled with Cymbalta 30mg, Lyrica 200mg daily. Now only on 30mg Cymbalta.
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Old 06-21-2013, 05:22 PM #3
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Are you taking the Cymbalta just for head aches ? That is a definite 'off label' use. The clinical trial I found for Cymbalta for head ache was a failure. The FDA has been very careful about approving Cymbalta for pain management because the studies have shown mixed or poor results.

What has your blood pressure been like ?

Has you doctor suggested trying propranolol or another beta-blocker to see it it helps ? It is more focused. Taking a strong anti-depressant for head aches sounds like too much meds for a very little range of symptoms.

I am liking being off anti-depressants and taking L-Tryptophan instead. The withdrawal from Paxil was not fun.

My best to you.
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Old 06-21-2013, 05:50 PM #4
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I agree that Cymbalta is primarily for mood and Amitriptyline is more for headache prevention.

Amitriptyline is the first thing that really cut through my headache (I did later switch to a different preventive as I couldn't handle the side effects). It can make you very sleepy, especially at first. This does get less over time. I needed a higher dose than 10 mg to really have the effect I was after. I was at 20 mg for a while, and when I went to 30 mg I started to get lightheaded and had to switch to Topamax.

If you don't have the dizziness with it, or if a low dose works for you, it may be quite helpful. You have to give it a couple of weeks to kick in. It will not be instantaneous by any means.

Hope this helps.
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mTBI and PCS after sledding accident 1-17-2011

Was experiencing:
Persistent headaches, fatigue, slowed cognitive functions, depression
Symptoms exacerbated by being in a crowd, watching TV, driving, other miscellaneous stress & sensory overload
Sciatica/piriformis syndrome with numbness & loss of reflex


Largely recovered after participating in Nedley Depression Recovery Program March 2012:

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Eowyn Rides Again: My Journey Back from Concussion

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Old 06-22-2013, 03:02 AM #5
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Thanks for the advice Eowyn I am glad it worked for you.

Mark I beg to differ with you because the increased dose from yesterday has resolved my headache. What is more it has erradicated the fatigue I was experiencing as well. Clinical trials are indicating that Cymbalta works for Neuropathic pain and Chronic Fatigue.

Cymbalta and Amytriptyline are both SNRIs and they are both effective for people for migraine prevention. Some people prefer Cymbalta, whilst others prefer Amytriptyline.

They are both effective because they are both prescribed by Neurologists for Migraine and as you are aware they are both antidepressants.

Cymbalta and Amytriptyline both restrict widened blood vessels, because they are SNRI's, and Cymbalta has pain killing qualities which are not fully understood by the medical profession.

I don't like the sound of Tricyclic's, Cymbalta is working for me so I won't be changing yet, increasing the dose to the recommended dose for migraine prevention 60mg is the way forward.
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PCS following head injury November 2012. Experienced dizzyness, light and noise sensitivity, hypercusis, fatigue, insomnia, migraines, facial pain, problems concentrating, irritability, sensory overload, exercise intolerance.

Symptoms mostly resolved, working full time and I am now mostly better. I wake 6am daily since my injury. Was experiencing daily Neuralgia which was controlled with Cymbalta 30mg, Lyrica 200mg daily. Now only on 30mg Cymbalta.

Last edited by mouse1; 06-22-2013 at 04:51 AM.
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Old 06-23-2013, 05:05 AM #6
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Just to let you know that the Cymbalta is working very nicely in preventing my headaches.

I think the fact that I have upped my activity levels and that I was only on the minimum dose of Cymbalta meant I was more prone to headaches.

Now that I have increased the dose to 60mg I have no problems with headache.
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PCS following head injury November 2012. Experienced dizzyness, light and noise sensitivity, hypercusis, fatigue, insomnia, migraines, facial pain, problems concentrating, irritability, sensory overload, exercise intolerance.

Symptoms mostly resolved, working full time and I am now mostly better. I wake 6am daily since my injury. Was experiencing daily Neuralgia which was controlled with Cymbalta 30mg, Lyrica 200mg daily. Now only on 30mg Cymbalta.
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