From the Guidelines
For head pain treatment, I recommend starting with over-the-counter medications like ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours with food, as it has been shown to be effective in reducing headache pain 1.
Key Considerations
- For migraines specifically, take medication at the first sign of symptoms and rest in a dark, quiet room.
- Staying hydrated, applying cold or warm compresses to the forehead or neck, and practicing stress reduction techniques like deep breathing can provide additional relief.
- If patients use an adequate dose of an NSAID or acetaminophen and still do not have sufficient pain relief, then add a triptan to an NSAID, or to acetaminophen when NSAIDs are contraindicated or not tolerated 1.
- Consider treating mild episodic migraine headache with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen.
- Although available comparative effectiveness data were uncertain, there is evidence supporting efficacy for CGRP antagonists-gepants (rimegepant, ubrogepant, or zavegepant) or ergot alkaloid (dihydroergotamine) for moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen 1.
Important Notes
- Do not use opioids or butalbital for the treatment of acute episodic migraine.
- Consider using a nonoral triptan and an antiemetic in people having severe nausea or vomiting.
- In people of childbearing potential and in those who are pregnant or breastfeeding, discuss the adverse effects of pharmacologic treatments during pregnancy and lactation.
- Counsel patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy (such as a triptan with an NSAID or acetaminophen) to improve efficacy 1.
From the FDA Drug Label
Sumatriptan presumably exerts its therapeutic effects in the treatment of migraine headache through agonist effects at the 5-HT1B/1D receptors on intracranial blood vessels and sensory nerves of the trigeminal system, which result in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.
Head pain treatment: Sumatriptan is used for the treatment of migraine headache. It works by constricting cranial blood vessels and inhibiting pro-inflammatory neuropeptide release.
- Key points: + Sumatriptan is a 5-HT1B/1D receptor agonist + It is used for the treatment of migraine headache + It constricts cranial blood vessels and inhibits pro-inflammatory neuropeptide release + It is contraindicated in patients with certain conditions, such as uncontrolled hypertension, CAD, and history of stroke or TIA [2] [3] 4
From the Research
Head Pain Treatment Options
- Acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine 5
- Migraine-specific treatments include triptans (5-HT1B/D agonists), which eliminate pain in 20% to 30% of patients by 2 hours, but are accompanied by adverse effects such as transient flushing, tightness, or tingling in the upper body in 25% of patients 5
- Gepants, antagonists to receptors for the inflammatory neuropeptide calcitonin gene-related peptide, such as rimegepant or ubrogepant, can eliminate headache symptoms for 2 hours in 20% of patients but have adverse effects of nausea and dry mouth in 1% to 4% of patients 5
- A 5-HT1F agonist, lasmiditan, is also available for acute migraine treatment and appears safe in patients with cardiovascular risk factors 5
Preventive Treatments
- Preventive treatments include antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, which reduce migraine by 1 to 3 days per month relative to placebo 5
- For migraine, various classes of preventives can be used (β-blockers, tricyclics, antiepileptics, botulinum toxin), with the choice of therapy tailored to the patient's risk factors and symptoms 6
- Tricyclics have the most evidence as prophylactic therapy for tension-type headache 6
- A new class of medication, monoclonal antibodies to calcitonin gene receptor peptide or its receptor, became available in 2018, and is the first class of medication specifically designed to treat migraine 6
Evaluation and Management
- A complete history is essential to identify the most likely headache type, indications of serious secondary headaches, and significant comorbidities 7
- A headache diary can document headache frequency, symptoms, initiating and exacerbating conditions, and treatment response over time 7
- Neurologic assessment and physical examination focused on the head and neck are indicated in all patients 7
- Imaging is generally not warranted for headache diagnosis 8
- Opioids should always be avoided in headache treatment 8, 9
- Behavioral strategies are important and should be part of any comprehensive headache management plan 8