From the Guidelines
The most effective treatment for post-traumatic headache with migraine features is a multimodal approach, including pharmacological and non-pharmacological interventions, with a focus on individualized care based on headache characteristics, comorbidities, and patient preferences.
Pharmacological Interventions
For acute treatment, aspirin–acetaminophen–caffeine is recommended due to its statistically significant improvement in critical outcomes, with a number needed to treat of 9 for pain freedom at 2 hours and 4 for pain relief at 2 hours 1. Additionally, ubrogepant and rimegepant, which are gepants, have shown moderately robust and clinically significant effects on critical outcomes of interest, such as pain freedom and pain relief at 2 hours, although they have a "weak for" recommendation 1.
Preventive Therapies
For prevention, CGRP monoclonal antibodies, including erenumab, fremanezumab, and galcanezumab, are recommended with a "strong for" recommendation due to their efficacy in reducing mean monthly migraine days and abortive medication use 1. Topiramate and valproate also have a "weak for" recommendation for the prevention of episodic migraine (EM) and chronic migraine (CM) due to their statistically significant reductions in monthly migraine days 1.
Non-Pharmacological Interventions
Non-pharmacological interventions, such as physical therapy and aerobic exercise, have a "weak for" recommendation for the management of migraine and tension-type headache (TTH), as they have been shown to reduce headache frequency and intensity 1. Cognitive behavioral therapy, mindfulness-based therapies, and progressive muscle relaxation may also be beneficial, although the evidence is mixed or insufficient to recommend for or against their use 1.
Individualized Care
Treatment should be tailored to the individual patient, taking into account their specific headache characteristics, comorbidities, and preferences. A multimodal approach, incorporating both pharmacological and non-pharmacological interventions, is often necessary to effectively manage post-traumatic headache with migraine features.
- Key considerations include:
- Headache type and frequency
- Presence of comorbid conditions, such as depression or anxiety
- Patient values and preferences
- Potential side effects and interactions of medications
- Access to non-pharmacological interventions, such as physical therapy and cognitive behavioral therapy By taking a comprehensive and individualized approach, clinicians can help patients with post-traumatic headache with migraine features achieve optimal outcomes and improve their quality of life.
From the FDA Drug Label
The efficacy of sumatriptan tablets in the acute treatment of migraine headaches was demonstrated in 3, randomized, double-blind, placebo-controlled trials. In all 3 trials, the percentage of patients achieving headache response 2 and 4 hours after treatment was significantly greater among patients receiving sumatriptan tablets at all doses compared with those who received placebo
The best treatment for post traumatic headache with migraine features is sumatriptan.
- Doses of 25,50, and 100 mg were compared with placebo in the treatment of migraine attacks.
- Headache response was assessed up to 4 hours after dosing, and maintenance of response was assessed for up to 24 hours postdose.
- Associated symptoms such as nausea, photophobia, and phonophobia were also assessed, and there was a lower incidence of these symptoms at 2 and 4 hours following administration of sumatriptan tablets compared with placebo 2
From the Research
Treatment Options for Post-Traumatic Headache with Migraine Features
- Pharmacologic management is often guided by the primary headache phenotype, with a phenotype-guided approach recommended 3
- Treatment may include abortive and prophylactic agents, with prophylaxis targeting comorbidities such as impaired sleep 4
- Non-pharmacologic interventions, including thermal and physical modalities, cognitive behavioral approaches, and education, may also be effective 4, 5
- Multimodal non-pharmacologic approaches, accounting for comorbidities and biopsychosocial factors, are often used in post-traumatic headache patients 5
- Combined pharmacological and non-pharmacological interventions, encompassing noninvasive neuromodulation, physical therapy, cognitive-behavioral treatment, and education, may be the best approaches for post-traumatic headache and related comorbidities 5
Pharmacologic Therapies
- Acute/preemptive pharmacological treatments for post-traumatic headache include drugs used for migraine and tension-type headaches 5
- Analgesics and non-steroidal anti-inflammatory drugs, tricyclic antidepressants, or antiepileptic medication may be used for pharmacological treatment 6
- Targeting calcitonin gene-related peptide signaling may be a promising therapeutic approach for post-traumatic headache 3
Non-Pharmacologic Interventions
- Cognitive behavioral therapy, relaxation techniques, biofeedback, and physical therapy may be used for post-traumatic headache treatment 6
- Noninvasive neuromodulation, physical therapy, cognitive-behavioral treatment, and education may be effective non-pharmacologic interventions 5
- A multidisciplinary approach to managing post-traumatic headache, including pharmacotherapy, cognitive behavioral therapy, and lifestyle changes, is recommended 6