What medication is recommended for a patient with headaches?

From the Guidelines

For patients with headaches, the most effective treatment approach is to start with over-the-counter pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium, and consider adding a triptan if necessary, as recommended by the American College of Physicians 1. When selecting a medication, it's essential to consider the severity of the headache and the patient's individual needs.

• For mild episodic migraine headaches, consider treating with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen 1.
• For moderate to severe acute episodic migraine headaches, consider using a triptan, such as sumatriptan, in combination with an NSAID or acetaminophen, or using a CGRP antagonist-gepant, such as rimegepant or ubrogepant, if the patient does not tolerate or has an inadequate response to combination therapy 1.
• It's also important to counsel patients to begin treatment as soon as possible after the onset of the headache and to be aware of the potential for medication overuse headache, which can occur when taking pain-relieving medications too frequently 1. Some key points to consider when treating patients with headaches include:
• Avoiding the use of opioids or butalbital for the treatment of acute episodic migraine 1
• Considering the use of a nonoral triptan and an antiemetic in people having severe nausea or vomiting 1
• Discussing the potential adverse effects of pharmacologic treatments during pregnancy and lactation with patients of childbearing potential 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

Recommended Medication:

• Sumatriptan (PO) is recommended for the treatment of migraine headaches.
• The dosage can be 25,50, or 100 mg, with 50 and 100 mg showing statistically significant greater headache response in some trials.
• It is essential to consider the patient's medical history, cardiovascular risk factors, and potential interactions with other medications before prescribing sumatriptan 2.

From the Research

Medication Options for Headaches

• The primary goals of acute migraine therapy are to reduce attack duration and severity, and current evidence-based therapies 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.
• Paracetamol (acetaminophen) 1000 mg alone is statistically superior to placebo in the treatment of acute migraine, with a number needed to treat (NNT) of 12 for pain-free response at two hours 4.
• Ibuprofen 400 mg is an effective treatment for acute migraine headaches, providing pain relief in about half of sufferers, with NNTs of 7.2,3.2, and 4.0 for 2-hour pain-free, 2-hour headache relief, and 24-hour sustained headache relief, respectively 5.
• Aspirin and NSAIDs are effective in treating migraine attacks, while triptans are highly effective in improving headache as well as nausea, photo- and phonophobia 6.
• Acetaminophen (1,000 mg) and aspirin (650 mg) are clinically similar in treating headaches, with recommendations for their use based on individual patient suitability and cost factors 7.

Comparison of Medications

• A comparison of 650 mg aspirin and 1,000 mg acetaminophen with each other and with placebo in moderately severe headache showed no differences between the effects of the active medications, but both were superior to placebo 7.
• Ibuprofen 400 mg did not differ from rofecoxib 25 mg for 2-hour headache relief, 24-hour headache relief, or use of rescue medication 5.
• Paracetamol 1000 mg plus metoclopramide 10 mg was not significantly different from oral sumatriptan 100 mg for 2-hour headache relief 4.