From the Guidelines
For a patient with a headache, the most effective discharge instruction is to take over-the-counter pain relievers such as ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed, not exceeding the maximum daily dose of 3200mg, as recommended by the most recent guideline from the American College of Physicians 1. When managing headache, it is essential to consider the severity and frequency of the episodes.
- For mild episodic migraine headache, consider treating with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen 1.
- If the patient does not achieve sufficient pain relief with an NSAID or acetaminophen, consider adding a triptan to an NSAID, or to acetaminophen when NSAIDs are contraindicated or not tolerated 1.
- Be aware that patients who do not tolerate or have inadequate response to a recommended migraine treatment may respond to another within the same drug class, and the choice of a specific NSAID or triptan should be based on individualized decision making, taking into consideration patient preferences on such factors as route of administration and cost 1. In addition to medication, it is crucial to advise patients to rest in a quiet, dark room, apply a cold or warm compress to their forehead or neck, stay hydrated, and avoid known triggers like alcohol, caffeine, or certain foods. If the headache is severe, sudden, accompanied by fever, neck stiffness, confusion, seizures, double vision, weakness, numbness, or follows a head injury, seek immediate medical attention. Return to the hospital if the headache worsens or doesn't improve within 48-72 hours despite medication. These recommendations help reduce inflammation and pain while addressing potential dehydration that can worsen headaches, and identifying and avoiding personal triggers is also crucial for preventing future episodes, as supported by the diagnosis and management of migraine in ten steps study 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Discharge Instructions for Headache
- The discharge instructions for a patient with a headache may vary depending on the diagnosis and treatment provided in the emergency department (ED) 2.
- Studies have shown that primary headaches are often underdiagnosed and misdiagnosed in the ED, and patients may not receive specific drug therapy either in the ED or at discharge 2, 3.
- For patients with primary headache disorders, such as migraine or tension-type headache, discharge instructions may include medication to manage pain and prevent recurrence 4, 5.
- Medications such as naproxen and sumatriptan have been shown to be effective in relieving post-ED recurrent primary headache and migraine 4.
- Discharge instructions may also include guidance on when to seek further medical attention, such as if the headache worsens or recurs, and how to manage symptoms at home 5.
- It is essential to provide patients with clear instructions on how to manage their headache and when to seek further medical attention to prevent unnecessary return visits to the ED 2, 5.
Medication Options
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium, and diclofenac potassium are commonly used to treat acute migraine 6.
- Triptans, such as sumatriptan, rizatriptan, and eletriptan, are also effective in treating acute migraine 6.
- Dihydroergotamine (DHE) may be suitable for selected patients with migraine 6.
- Antiemetic drugs may be added to medication regimens as necessary to manage nausea and vomiting 6.
Follow-up Care
- Patients with primary headache disorders may require follow-up care to manage their condition and prevent recurrence 5.
- Discharge instructions may include guidance on when to follow up with a healthcare provider and how to manage symptoms in the interim 5.
- Patients with migraine or other primary headache disorders may benefit from referral to a headache specialist for further evaluation and management 2.