What are the treatment options for headaches?

From the Guidelines

Treatment for headaches should prioritize a combination of medication and non-medication approaches, with a focus on early intervention and individualized treatment plans, as recommended by the most recent guidelines from the American College of Physicians 1.

Medication Options

For mild to moderate headaches, over-the-counter pain relievers such as:

• Acetaminophen (Tylenol) at 325-650mg every 4-6 hours
• Ibuprofen (Advil, Motrin) at 200-400mg every 4-6 hours
• Aspirin at 325-650mg every 4-6 hours can be effective. For more severe headaches, prescription medications may be necessary, such as:
• Triptans (like sumatriptan 50-100mg) for migraines
• Preventive medications like propranolol (20-80mg daily), topiramate (25-100mg daily), or amitriptyline (10-50mg at bedtime) for frequent headaches.

Non-Medication Approaches

Non-medication approaches include:

• Staying hydrated
• Maintaining regular sleep patterns
• Managing stress through relaxation techniques
• Applying cold or hot compresses to the head or neck
• Avoiding known triggers like certain foods, alcohol, or strong scents. For tension headaches, gentle massage, stretching, and improving posture can help relieve muscle tension that contributes to pain.

Special Considerations

If headaches are severe, persistent, or accompanied by concerning symptoms like fever, stiff neck, or neurological changes, medical attention should be sought immediately as these could indicate a more serious condition. It's also important to consider lifestyle modifications, such as:

• Maintaining regular meals
• Securing sufficient and consistent sleep
• Engaging in regular physical activity
• Managing stress with relaxation techniques or mindfulness practices
• Pursuing weight loss for those who are overweight or obese, as recommended by recent studies 1.

Preventive Treatments

Preventive treatments may be considered for patients with frequent or disabling headaches, or those with medication overuse, with options including amitriptyline, topiramate, and CGRP monoclonal antibodies, as discussed in recent guidelines 1.

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 treatment options for headaches include sumatriptan tablets, which have been shown to be effective in the acute treatment of migraine headaches.

• Doses of 25,50, and 100 mg were compared with placebo in the treatment of migraine attacks.
• Headache response was defined as a reduction in headache severity from moderate or severe pain to mild or no pain.
• The estimated probability of achieving an initial headache response over the 4 hours following treatment is depicted in Figure 1 2.
• Additional treatments such as acetaminophen were allowed 4 to 24 hours after the initial treatment for recurrent headache or as rescue in all 3 trials 2.

From the Research

Treatment Options for Headaches

• The primary goals of acute migraine therapy are to reduce attack duration and severity, and current evidence-based therapies for acute migraine attacks include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, and anti-emetics 3.
• Over-the-counter medications, such as acetaminophen, ibuprofen, naproxen, and aspirin, have shown strong efficacy when used as first-line treatments for mild-to-moderate migraine attacks 3, 4.
• Paracetamol (acetaminophen) 1000 mg alone is an effective treatment for acute migraine headaches, and the addition of 10 mg metoclopramide gives short-term efficacy equivalent to oral sumatriptan 100 mg 5.
• Sumatriptan is a potent and selective agonist at the vascular 5HT1 receptor and is effective in relieving migraine headaches, with approximately 70 to 80% of patients experiencing relief of migraine headaches by 1 or 2 hours after administration 6.

Medication-Specific Treatment Options

• Acetaminophen and NSAIDs are first-line treatments for mild to moderate migraines, whereas triptans are first-line treatments for moderate to severe migraines 7.
• Sumatriptan 100 mg administered orally is clearly superior to placebo in the acute treatment of migraine headache and achieves significantly greater response rates than ergotamine or aspirin 6.
• Dihydroergotamine and antiemetics are recommended for use as second- or third-line therapy for select patients or for those with refractory migraine 7.

Considerations for Treatment

• Patients who experience disability during the predominance of their attacks are poor candidates for over-the-counter-exclusive therapy and should seek a physician's help for migraine-specific prescription drugs 4.
• The pharmacologic properties, potential adverse effects, cost, and routes of administration vary widely, allowing therapy to be individualized based on the pattern and severity of attacks 7.
• Adverse event rates were similar between paracetamol and placebo, and between paracetamol plus metoclopramide and sumatriptan, but "major" adverse events were slightly more common with sumatriptan than with paracetamol plus metoclopramide 5.