From the Guidelines
Treating chronic daily headaches requires a preventive treatment approach, considering medications such as beta blockers, topiramate, or candesartan as first-line options, as recommended in the 2021 study published in Nature Reviews Neurology 1. When managing chronic daily headaches, it's essential to consider the frequency and impact of headaches on the patient's life.
- The treatment plan should include preventive strategies to reduce the frequency and severity of headaches.
- First-line medications, as suggested by the study 1, include beta blockers (atenolol, bisoprolol, metoprolol, or propranolol), topiramate, or candesartan.
- These medications have been shown to be effective in reducing headache frequency and improving quality of life.
- In addition to medication, lifestyle modifications such as maintaining regular sleep patterns, staying hydrated, reducing caffeine and alcohol intake, and practicing stress management techniques can also be beneficial.
- The use of CGRP monoclonal antibodies as third-line medications, as recommended by the study 1, may be considered for patients who do not respond to first-line treatments.
- Other adjunctive therapies, such as neuromodulatory devices, biobehavioural therapy, and acupuncture, may also be considered as part of a comprehensive treatment plan.
- It's crucial to work with a healthcare provider to develop a personalized treatment plan that addresses the patient's specific needs and medical history.
From the FDA Drug Label
to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day. The FDA-approved treatment for chronic daily headaches is onabotulinumtoxinA (IM), which is used to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day 2.
- Key points:
- OnabotulinumtoxinA (IM) is used for chronic migraine prevention.
- It is not explicitly stated for chronic daily headaches, but chronic migraine can be considered a type of chronic daily headache.
- Sumatriptan (PO) is used for acute migraine treatment, not prevention of chronic daily headaches 3.
From the Research
Treatment Options for Chronic Daily Headaches
- Medications such as valproate sodium 4, amitriptyline, gabapentin, onabotulinumtoxinA, propranolol, tizanidine, topiramate 5, 6, 7 can be used to reduce headache frequency and severity.
- Nonpharmacologic treatments including relaxation techniques, cognitive behavior therapy, acupuncture, osteopathic manipulation, and cervical exercises 5, 8, 7 can also be effective.
- Withdrawal therapy, combined with prophylaxis using topiramate and amitriptyline, can be beneficial for patients with chronic daily headache and medication overuse 6.
Management of Chronic Daily Headaches
- Identifying and managing environmental, dietary, and behavioral triggers is useful in preventing migraines 8.
- Preventive medication therapy can reduce migraine frequency, severity, and headache-related distress, and may also improve quality of life and prevent the progression to chronic migraines 8.
- The choice of prophylactic drugs depends on efficacy, co-morbidity, side effects, availability, and cost 7.
Prophylactic Treatments
- First-line medications established as effective include divalproex, topiramate, metoprolol, propranolol, and timolol 8.
- Medications such as amitriptyline, venlafaxine, atenolol, and nadolol are probably effective but should be second-line therapy 8.
- Complementary treatments like petasites, feverfew, magnesium, and riboflavin are probably effective 8.