From the Guidelines
Daily persistent headaches should be treated with a combination of preventive medications, such as antidepressants or anticonvulsants, and non-pharmacological approaches, like stress management and lifestyle modifications, to minimize the risk of medication-overuse headache and improve quality of life. The treatment options for daily persistent headaches include:
- Preventive medications:
- Antidepressants like amitriptyline (10-150 mg daily) or venlafaxine (75-225 mg daily)
- Anticonvulsants such as topiramate (25-200 mg daily) or gabapentin (300-3600 mg daily)
- Beta-blockers like propranolol (40-240 mg daily)
- Acute treatment:
- NSAIDs like ibuprofen (400-800 mg) or naproxen (500-1000 mg), limited to 2-3 days per week to avoid medication overuse headaches
- Triptans like sumatriptan (50-100 mg) for severe episodes
- Non-pharmacological approaches:
- Stress management techniques
- Regular sleep schedules
- Adequate hydration
- Trigger avoidance
- Physical therapy, acupuncture, biofeedback, and cognitive behavioral therapy According to the studies 1, medication-overuse headache is a significant concern in patients with daily persistent headaches, and preventive therapy should be considered to minimize this risk. A multidisciplinary approach combining medication and lifestyle modifications typically yields the best results, and treatment plans often need adjustment over time based on individual response.
From the Research
Treatment Options for Daily Persistent Headaches
The treatment options for daily persistent headaches can be categorized into non-pharmacologic and pharmacologic therapies.
- Non-pharmacologic treatments include:
- Pharmacologic therapies include:
Abortive Treatments
For acute migraine attacks, combination treatments such as sumatriptan plus naproxen have been shown to be effective in providing pain-free and headache relief responses 6.
Prophylactic Treatments
Prophylactic treatments, such as those used for migraine, can reduce headache frequency and severity, and improve overall quality of life 2, 3, 5. The choice of prophylactic drug depends on efficacy, co-morbidity, side effects, availability, and cost 3.
Lifestyle Modification
Lifestyle modification has been shown to play a significant role in managing chronic daily headaches, and can include stress management, relaxation techniques, and avoidance of trigger factors 4.