What is the best treatment for a headache after travel?

Treatment of Headache After Travel

For headache after travel, NSAIDs are the first-line treatment option, with ibuprofen, aspirin, or naproxen sodium being most effective. 1, 2, 3

First-Line Treatment Options

• NSAIDs are recommended as first-line therapy for most post-travel headaches, which are often migraine-like in nature 1, 2, 3
• Specific NSAID options with strong evidence include:
  • Aspirin (650-1000 mg every 4-6 hours) 2, 3
  • Ibuprofen (400-800 mg every 6 hours) 2, 3
  • Naproxen sodium (275-550 mg every 2-6 hours) 2, 3
  • Diclofenac potassium 3
• Combination of acetaminophen plus aspirin plus caffeine is effective, though acetaminophen alone has insufficient evidence 1, 2
• For airplane travel-specific headaches, taking NSAIDs preventively before flying may help prevent headache during ascent and descent 4, 5

Second-Line Treatment Options

• If NSAIDs fail to provide adequate relief, add a triptan 1, 3
• The American College of Physicians strongly recommends adding a triptan to an NSAID for moderate to severe headache when NSAID alone is inadequate (strong recommendation, moderate-certainty evidence) 1
• Triptans with good evidence include:
  • Sumatriptan (oral or subcutaneous) 1, 3
  • Rizatriptan 1, 2
  • Naratriptan 1, 2
  • Zolmitriptan 1, 2
• Combination therapy of triptan plus NSAID provides superior efficacy compared to either medication alone, with:
  • Higher likelihood of sustained pain relief (130 more events per 1000 treated people) 1
  • Lower likelihood of needing rescue medication (130 fewer events per 1000 treated people) 1

Managing Nausea and Vomiting

• If nausea or vomiting is a significant component, add an antiemetic and consider non-oral routes of administration 1, 3, 6
• Metoclopramide (10 mg IV or oral) can effectively treat accompanying nausea and improve gastric motility 2, 6
• Prochlorperazine can relieve both headache pain and nausea 2, 6
• For airplane travel-specific headaches with significant nausea, non-oral routes may be particularly important 4, 5

Special Considerations for Travel-Related Headaches

• Airplane headaches typically present as severe, unilateral pain in the fronto-orbital region during takeoff or landing, usually resolving within 30 minutes 4, 5, 7
• These headaches are more common than previously thought, affecting approximately 14.2% of frequent flyers 7
• Preventive strategies for airplane headaches include:
  • Taking NSAIDs 30-60 minutes before flight 4, 5
  • Nasal decongestants before flight if sinus congestion is present 4
  • Staying well-hydrated before and during travel 6

Important Cautions

• Limit acute treatments to no more than twice weekly to prevent medication overuse headache 2, 3, 6
• Avoid opioids and butalbital-containing medications for travel headaches due to risk of dependency and medication overuse headache 6
• Triptans are contraindicated in patients with uncontrolled hypertension, coronary artery disease, and certain types of migraine (basilar or hemiplegic) 2
• NSAIDs should be used cautiously in patients with gastrointestinal issues, renal impairment, or aspirin/NSAID-induced asthma 2

When to Consider Preventive Treatment

• Consider preventive medications if headaches occur frequently with travel (two or more attacks per month with disability lasting 3+ days) 1, 2
• First-line preventive options include:
  • Propranolol (80-240 mg daily) 1, 2
  • Timolol (20-30 mg daily) 1, 2
  • Amitriptyline (30-150 mg daily) 1, 2
  • Divalproex sodium (500-1500 mg daily) 1, 2