From the Guidelines
Headache management should begin with taking a detailed history and making a specific headache diagnosis, as this approach is crucial for effective treatment and has a moderate level of evidence supporting it 1. When diagnosing and managing headaches, it is essential to consider the following key points:
- Take a detailed history to make a specific headache diagnosis 1
- Advise patients and families on lifestyle factors, migraine triggers, and avoidance of acute medication overuse 1
- Counsel patients to treat acute migraine early in the attack 1
- Use ibuprofen to treat pain in children and adolescents, and consider sumatriptan, naproxen, zolmitriptan, or rizatriptan for adolescents 1
- Consider preventive treatments in children and adolescents with frequent or disabling headaches or medication overuse 1 Some important considerations in headache management include:
- Discussing the evidence for and side effects of amitriptyline combined with cognitive behavioral therapy, topiramate, and propranolol for migraine prevention 1
- Being aware of the potential teratogenic effects of topiramate and valproate 1
- Using non-oral triptans or adding anti-emetics for patients with nausea or vomiting 1 The most effective approach to headache management is a multifaceted one that incorporates lifestyle modifications, acute treatment, and preventive strategies, as supported by the highest quality evidence 1.
From the FDA Drug Label
Limitations of Use: Use only if a clear diagnosis of migraine headache has been established. Before treating headaches in patients not previously diagnosed as migraineurs, and in migraineurs who present with atypical symptoms, exclude other potentially serious neurological conditions.
The guidelines for diagnosing headaches include establishing a clear diagnosis of migraine headache before using sumatriptan. It is also important to exclude other potentially serious neurological conditions in patients not previously diagnosed as migraineurs or in those with atypical symptoms. 2 2
Key considerations for managing headaches with sumatriptan include:
- Establishing a clear diagnosis of migraine headache
- Excluding other serious neurological conditions
- Using sumatriptan only for acute treatment of migraine with or without aura in adults
- Not using sumatriptan for prophylactic therapy of migraine attacks or for the treatment of cluster headache.
From the Research
Diagnosis of Headaches
- The diagnosis of headaches involves evaluating patients to determine whether their headache is a primary or secondary headache disorder 3
- Primary headache disorders are defined as headaches that are unrelated to an underlying medical condition and are categorized into 4 groups: migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary headache disorders 3
- Secondary headache disorders are defined as headaches due to an underlying medical condition and are classified according to whether they are due to vascular, neoplastic, infectious, or intracranial pressure/volume causes 3
Management of Headaches
- Acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine 3, 4
- Migraine-specific treatments include triptans, gepants, and lasmiditan, which can eliminate pain in 20% to 30% of patients by 2 hours 3, 4
- Preventive treatments include antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, which can reduce migraine by 1 to 3 days per month relative to placebo 3
- Nonpharmacologic treatments, such as behavioral treatments, acupuncture, and lifestyle modifications, can also be effective in managing headaches 5, 6
Lifestyle Modifications
- Lifestyle modifications, such as maintaining a regular sleep and meal schedule, adequate hydration, limited consumption of caffeine, tobacco, and alcohol, and regular physical activity, can help prevent headaches 6
- Educational programs that advise pediatric patients to follow a correct lifestyle can improve quality of life and assist adult patients in avoiding headache chronicity 6
- The ketogenic diet is a possible new therapeutic strategy for the control of headache in adults, but more studies are needed to determine its effectiveness in children and adolescents 6