Brief Answer:
Too many medications!

Detailed Answer:
I read your question carefully and I appreciate your concern about your friend.

Reading you question and the medications though I must say I am a little confused and concerned about the meds she's taking.

You say she's on Desvenlafaxine (Pristiq), has been started on Imipramine and then mention her taking Amitriptyline (Elavil). They are all three antidepressants and are not commonlly used together. They all have a warning about increasing risk of suicide on initiation in patients under 24 years of age.

Elavil may be used for migraine prevention but not a first choice at that age (better prevention first choices would be antihypertensives - propranolol, verapamil). Also they all alter neurotransmitter balance, which while in some patients can prevent headache in others this disrupted balance can trigger it, so they all have headache listed as a possible side effect Pristiq in particular.

So what I am trying to say is that headache and fatigue she's feeling may be due to too much medication sometimes, rather than be helped by them. I do not know who prescribed them and for what indication but I think at least temporarily should be checked and followed by a psychiatrist or neurologist, as it seems a tricky situation and medication combination for a GP to handle, unless someone with prior training or experience in the antidepressant use.

It makes it also difficult to recommend other treatments for migraine attack. That is because some of the most used medications, the triptan and ergotamine class when combined with antidepressants have the risk of a serious life threatening condition called serotonine syndrome, the risk is low but with 3 antidepressants it's real.
So for the pain I can recommend only over the counter anti-inflammatory pain killers like Ibuprofen or Indomethacin when there is an acute migraine attack. I would not continue imipramine and discuss with the doctor the necessity of the other two antidepressants as well.

I remain at your disposal for other questions

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Brief Answer:
Yes she can use Ibuprofen.

Detailed Answer:
Thank you for the update. I still do not see any benefit from using imipramine and amitriptyline interchangeably to be honest.

As for Ibuprofen or some other anti-inflammatory (NSAID) yes she can use it with Pristiq. There is no interaction between the two at all. Actually if she's used Excedrine, she already has used some anti-inflammatory with Pristiq as it contains some aspirin among the other components, the originating anti-inflammatory to which the NSAIDs followed.

I hope to have been of help.

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Brief Answer:
Ibuprofen does not cause serotonin syndrome

Detailed Answer:
Hello again.

You apologize again for the brand name issue, no problem at all, but just to be sure we are clear I will resume: Imipramine is the name of the drug, not a brand name, there may be different brands in the market with names that may vary.
Pristiq is the brand name for the drug called Desvenlafaxine, Elavil is the brand name for a drug called Amitriptyline.

Regarding the Ibuprofen issue, it is not true, Ibuprofen or other classic NSAIDs do not cause serotonin syndrome, you have have been misinformed. The medication which can cause serotonin syndrome when used with antidepressants is the class of triptans or ergotamine derivatives as I already mentioned. So Ibuprofen is fine no worry about that (can check for interactions yourself at the following site if you need reassurance http://reference.medscape.com/drug-interactionchecker )

It is actually the imipramine and Pristiq together which carries that risk (though that dosage of Imipramine is really low, so very low risk).

Wishing you good health.

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