Amitriptyline is not significantly different from placebo when used for the prevention of migraine in children.Amitriptyline may reduce the frequency and duration of chronic tension headache, but it is associated with worse adverse effects than mirtazapine. Overall, amitriptyline is recommended for tension headache prophylaxis, along with lifestyle advice, which should include avoidance of analgesia and caffeine. Other indications
Amitriptyline is effective for the treatment of irritable bowel syndrome; however, because of its side effects, it should be reserved for select patients for whom other agents do not work. There is insufficient evidence to support its use for abdominal pain in children with functional gastrointestinal disorders.Tricyclic antidepressants decrease the frequency, severity, and duration of cyclic vomiting syndrome episodes. Amitriptyline, as the most commonly used of them, is recommended as a first-line agent for its therapy.Amitriptyline may improve pain and urgency intensity associated with bladder pain syndrome and can be used in the management of this syndrome. Amitriptyline can be used in the treatment of nocturnal enuresis in children. However, its effect is not sustained after the treatment ends. Alarm therapy gives better short- and long-term results.In the US, amitriptyline is commonly used in children with ADHD as an adjunct to stimulant medications without any evidence or guideline supporting this practice. Many physicians in the UK (and the US also) commonly prescribe amitriptyline for insomnia; however, Cochrane reviewers were not able to find any randomized controlled studies that would support or refute this practice.
Medical Procedures
Aspiration and sclerotherapy are treatments that remove fluid from the spermatocele and seal the spermatocele sac closed from further fluid build-up, respectively. Due to a higher risk of epididymis damage, fertility problems, and further recurrences, these procedures are not recommended and not commonly used. Surgical Treatments
Surgical treatments must be thoroughly discussed with people prior to any final decisions. Different types of surgical procedures may be chosen based on the extent of risk.A short procedure called a spermatocelectomy can be performed for spermatoceles that cause irritating symptoms. This standard procedure can be performed in an outpatient setting with the use of local or general anesthesia. This procedure typically consists of removing the spermatocele and a portion of the epididymis. The risk of epididymal injury is 17.12%. This incident may happen when the spermatocele is being dissected from the head of the epididymis. Spermatocelectomy can cause complications such as hematoma, wound infection, scrotal abscess as well as recurrence. After surgery, the doctor may recommend to apply ice packs for several days to help reduce swelling. Oral pain medications can also be taken for a few days to reduce discomfort. In addition, the patient returns 2–6 weeks after to inspect any progress/complications. If received a vasectomy, then two semen samples must be collected and analyzed after 6–12 weeks post-operation and several ejaculations. The centrifuged semen samples are used to look for the absence of viable sperm in the semen. Risk of Complications
After surgical removal, it is possible that the pain will persist and recurrence can occur.