What are the recommendations for headache prevention and treatment?

Headache Prevention: Patient Education Guide

The most effective approach to headache prevention combines lifestyle modifications with appropriate pharmacologic treatments when indicated, starting with beta-blockers (propranolol/timolol), antiseizure medications (valproate), SNRIs (venlafaxine), or TCAs (amitriptyline) as first-line options. 1

Understanding Your Headaches

• Identifying the specific type of headache you experience is crucial for effective prevention and treatment 1, 2
• Migraine headaches typically cause moderate to severe pain, often on one side of the head, and may be accompanied by nausea, vomiting, and sensitivity to light and sound 3
• Tension-type headaches usually cause mild to moderate pain on both sides of the head with a pressing or tightening quality 3

Lifestyle Modifications for Headache Prevention

Sleep Habits

• Maintain regular sleep patterns by going to bed and waking up at the same time each day 1, 2
• Aim for 7-9 hours of quality sleep per night 4
• Both insufficient sleep and oversleeping can trigger headaches, particularly migraines 5

Diet and Hydration

• Stay well-hydrated by drinking at least 8 glasses of water daily 1, 2
• Eat regular meals and avoid skipping meals, as this can trigger headaches 1, 4
• Keep a food diary to identify potential food triggers, which may include:
  • Aged cheeses and processed meats containing tyramine 6
  • Foods with artificial sweeteners like aspartame 6
  • Foods containing MSG (monosodium glutamate) 6
  • Caffeine (both consumption and withdrawal) 6
  • Alcohol, particularly red wine 6

Physical Activity

• Engage in regular moderate physical activity, which can help reduce headache frequency 1, 2
• Start slowly and gradually increase intensity to avoid exercise-induced headaches 4
• Consider activities like walking, swimming, or cycling 4

Stress Management

• Practice stress-reduction techniques such as:
  • Deep breathing exercises 2
  • Progressive muscle relaxation 7
  • Mindfulness meditation 1
  • Cognitive behavioral therapy 7

When to Consider Medication for Prevention

Indications for Preventive Treatment

• Experiencing two or more migraine attacks per month with disability lasting 3 or more days 1
• Using acute headache medications more than twice per week 1
• Headaches that significantly impact your quality of life despite lifestyle modifications 1
• Contraindications to or failure of acute treatments 1

First-Line Preventive Medications

• Beta-blockers: Propranolol (80-240 mg/day) or timolol (20-30 mg/day) 1, 2, 8
• Tricyclic antidepressants: Amitriptyline (30-150 mg/day) 1, 2
• Anticonvulsants: Divalproex sodium (500-1,500 mg/day) or topiramate 1, 2
• SNRIs: Venlafaxine 1
• CGRP antagonists (newer options): Atogepant, rimegepant, or CGRP-mAbs (eptinezumab, erenumab, fremanezumab, galcanezumab) 1

Important Medication Considerations

• Start with low doses and gradually increase to minimize side effects 1, 2
• Allow 2-3 months for preventive medications to show full effectiveness 1, 2
• Women of childbearing potential should discuss potential risks of certain medications (especially valproate and topiramate) with their healthcare provider 1, 2
• If one medication is ineffective or causes intolerable side effects, your provider may recommend trying another option 1

Complementary Approaches

• Certain supplements may help prevent migraines:
  • Magnesium 6
  • Riboflavin (vitamin B2) 6
  • Coenzyme Q10 6
  • Feverfew 6
• Discuss these options with your healthcare provider before starting any supplements 6

Tracking Your Headaches

• Keep a headache diary to:
  • Identify triggers 1
  • Monitor effectiveness of preventive strategies 1
  • Track frequency and severity of headaches 1
  • Document medication use to avoid overuse 1, 7

Warning Signs to Contact Your Healthcare Provider

• Sudden, severe headache described as "the worst headache of your life" 3
• New headache pattern after age 50 3
• Headache with fever, stiff neck, confusion, seizures, double vision, weakness, or numbness 3
• Headache after head injury 3
• Headache that worsens with coughing, exertion, or sudden movement 3
• Headaches that don't respond to treatment 3