From the Guidelines
For daily headaches in the Southeast region, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) are typically recommended first-line medications. Start with acetaminophen 500-650mg every 6 hours as needed (not exceeding 3000mg daily) or ibuprofen 400-600mg every 6-8 hours with food (not exceeding 3200mg daily) 1. For patients who recently moved from overseas, these medications are widely available over-the-counter in the US and generally affordable.
Key Considerations
- If these don't provide relief after 2-3 weeks of proper use, consult a healthcare provider as daily headaches may indicate an underlying condition requiring different treatment.
- Proper hydration (8-10 glasses of water daily), regular sleep patterns, stress management, and avoiding known triggers like certain foods or environmental factors can complement medication.
- Be cautious about medication overuse headaches, which can develop from taking pain relievers more than 10-15 days per month; this is why medical evaluation is important for persistent headaches.
Additional Treatment Options
- Consider preventive treatment in patients who are adversely affected by migraine on ≥2 days per month despite optimized acute treatment 1.
- Use beta blockers, topiramate, or candesartan as first-line medications for preventive treatment 1.
- Consider CGRP monoclonal antibodies as third-line medications for preventive treatment 1.
From the FDA Drug Label
The efficacy of sumatriptan tablets was unaffected by presence of aura; duration of headache prior to treatment; gender, age, or weight of the subject; relationship to menses; or concomitant use of common migraine prophylactic drugs (e.g., beta-blockers, calcium channel blockers, tricyclic antidepressants).
A common medication for daily headaches in a patient with a history of recent international relocation to the Southeast region is sumatriptan.
- Key considerations:
- The patient should be diagnosed with migraine headaches.
- The medication should be used with caution due to potential side effects, such as serotonin syndrome, increase in blood pressure, and anaphylactic reactions.
- Patients with a history of stroke, TIA, or uncontrolled hypertension should not use sumatriptan.
- The efficacy of sumatriptan is not affected by the presence of aura or concomitant use of common migraine prophylactic drugs 2. However, the FDA label does not provide information on the management of daily headaches, and sumatriptan is indicated for the treatment of migraine headaches. Therefore, the use of sumatriptan for daily headaches should be approached with caution and under the guidance of a healthcare professional.
From the Research
Medication Options for Daily Headaches
- Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line treatments for mild to moderate migraines 3
- Triptans are first-line treatments for moderate to severe migraines, but may be expensive 3, 4
- Antiemetics, ergot alkaloids, and combination analgesics also have evidence supporting their effectiveness in the treatment of migraine 3
- For patients with chronic daily headaches, the goal is to effectively reduce the days of headache through preventive treatment as well as complementary therapies 5
Considerations for Patients with Recent International Relocation
- Patients presenting with headache should be evaluated to determine whether their headache is most likely a primary or a secondary headache disorder 6
- Evaluation should include consideration of red flags and focused neurologic examination 7
- Treatment options may vary depending on the underlying cause of the headache and the patient's medical history 6, 7
Treatment Principles
- Taking medication early in an attack and using a stratified treatment approach can help ensure that migraine treatment is cost-effective 3
- Limiting the use of abortive therapy can help avoid medication-overuse headaches (MOH) 5
- A variety of medications is available for the treatment of primary headaches, including antidopaminergic agents, triptans, and nerve blocks 7