What is the best treatment for primary headaches?

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Last updated: June 10, 2025 • View editorial policy

From the Guidelines

The most effective treatment for primary headaches, particularly migraines, involves the use of triptans such as sumatriptan (25-100mg orally) for acute attacks, as evidenced by studies 1, 2. For tension headaches, over-the-counter pain relievers like acetaminophen (Tylenol) 500-1000mg or NSAIDs such as ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed are effective first-line treatments. However, for migraines, the first-line therapy includes aspirin, ibuprofen, naproxen sodium, tolfenamic acid, and the combination agent acetaminophen plus aspirin plus caffeine, as recommended by 1. In patients whose migraine attack has not responded to NSAIDs, migraine-specific agents (triptans, DHE) should be used, with good evidence for oral naratriptan, rizatriptan, and zolmitriptan; oral and subcutaneous sumatriptan; and DHE nasal spray, as stated in 1. Additionally, lifestyle modifications are crucial, including regular sleep patterns, stress management, avoiding trigger foods, staying hydrated, and maintaining regular exercise, as these can help reduce the frequency and severity of headaches. It's also important to note that migraine sufferers should be evaluated for use of preventive therapy, with recommended first-line agents including propranolol, timolol, amitriptyline, divalproex sodium, and sodium valproate, as indicated by 1. Overall, the treatment of primary headaches should be tailored to the individual patient, taking into account the specific type of headache, frequency, and severity, as well as any underlying medical conditions or concerns. Some key points to consider when treating primary headaches include:

  • Identifying and avoiding trigger factors
  • Using lifestyle modifications to reduce stress and promote relaxation
  • Selecting the most effective medication for the specific type of headache
  • Monitoring for potential side effects and interactions with other medications
  • Considering preventive therapy for frequent or severe headaches.

From the Research

Treatment Options for Primary Headaches

  • Acute treatment for migraine includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine 3
  • Migraine-specific treatments include triptans, 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 3
  • Gepants, antagonists to receptors for the inflammatory neuropeptide calcitonin gene-related peptide, 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 3
  • A 5-HT1F agonist, lasmiditan, is also available for acute migraine treatment and appears safe in patients with cardiovascular risk factors 3

Preventive Treatments for Primary Headaches

  • 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 3
  • First-line medications established as effective based on clinical evidence include divalproex, topiramate, metoprolol, propranolol, and timolol 4
  • Medications such as amitriptyline, venlafaxine, atenolol, and nadolol are probably effective but should be second-line therapy 4
  • Complementary treatments such as petasites, feverfew, magnesium, and riboflavin are probably effective 4
  • Nonpharmacologic therapies such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy also have good evidence to support their use in migraine prevention 4

Over-the-Counter Treatment for Chronic Migraine Headaches

  • Over-the-counter medications are an important component of migraine therapy and are considered a first-line therapy for most migraineurs 5
  • Medications such as acetaminophen, ibuprofen, naproxen, and aspirin have shown strong efficacy when used as first-line treatments for mild-to-moderate migraine attacks 5
  • The lower cost of over-the-counter medications compared with prescription medications also makes them a preferred therapy for some patients 5
  • In addition to their efficacy and lower cost, over-the-counter medications generally have fewer and less severe adverse effects, have more favorable routes of administration, and reduced abuse potential 5

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.