From the Guidelines
The primary treatment for headache disorders, particularly migraines, should involve a combination of lifestyle modifications and medications, with beta blockers, topiramate, or candesartan considered as first-line medications for prevention, as recommended by the most recent guidelines 1. When considering treatment for headache disorders, it's essential to differentiate between acute and preventive treatments. For acute migraine attacks, medications such as triptans (e.g., sumatriptan) or a combination of acetaminophen, aspirin, and caffeine can be effective 1. However, the most recent and highest quality study suggests that for preventive treatment, beta blockers (like atenolol, bisoprolol, metoprolol, or propranolol), topiramate, or candesartan should be considered as first-line medications 1.
Key considerations in managing headache disorders include:
- Identifying and avoiding triggers
- Maintaining a regular sleep pattern
- Staying hydrated
- Managing stress
- Regular exercise
- Keeping a headache diary to track patterns and potential triggers
For patients who experience frequent or disabling migraines, preventive treatment should be considered, with the goal of reducing the frequency and severity of attacks. The choice of preventive medication should be based on the individual patient's needs and medical history, with consideration of potential side effects and interactions with other medications.
In terms of specific medications, the evidence supports the use of:
- Beta blockers (e.g., propranolol) for prevention of migraines 1
- Topiramate for prevention of migraines 1
- Triptans (e.g., sumatriptan) for acute treatment of migraines 1
- Ibuprofen for acute treatment of migraines in children and adolescents 1
Overall, the treatment of headache disorders should be individualized, taking into account the patient's specific needs and medical history, and guided by the most recent and highest quality evidence available. The use of beta blockers, topiramate, or candesartan as first-line medications for preventive treatment of migraines is supported by the most recent guidelines 1.
From the Research
Primary Treatments for Headache Disorders
The primary treatments for headache disorders can be categorized into acute and preventive treatments.
- Acute treatments are used to relieve symptoms during an attack, while preventive treatments are used to reduce the frequency and severity of attacks.
Acute Treatments
Acute treatments for headache disorders include:
- Simple analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3, 4
- Triptans, such as sumatriptan, which are effective for moderate to severe migraines 3, 4, 5
- Antiemetics, which are used to relieve nausea and vomiting 3, 4, 6
- Ergot alkaloids, which are used to treat migraines 3
Preventive Treatments
Preventive treatments for headache disorders include:
- Amitriptyline, which is the best-studied drug for preventing tension-type headaches 2
- Nortriptyline, mirtazapine, tizanidine, and selective serotonin reuptake inhibitors, which can be used to prevent tension-type headaches 2
- β-blockers, tricyclics, antiepileptics, and botulinum toxin, which can be used to prevent migraines 6
- Monoclonal antibodies to calcitonin gene receptor peptide or its receptor, which are a new class of medication specifically designed to treat migraines 6
Nonpharmacologic Interventions
Nonpharmacologic interventions, such as neuromodulation, can also be used to treat headache disorders 6.
- Over-the-counter medications, such as acetaminophen, ibuprofen, naproxen, and aspirin, are an important component of migraine therapy and are considered a first-line therapy for most migraineurs 4.