What medications can be administered for headache, including potential side effects to consider?

From the Guidelines

For headache management, NSAIDs such as ibuprofen or diclofenac potassium should be used as first-line medication, as recommended by the most recent guidelines 1. When considering medication for headache, it's essential to weigh the benefits and potential side effects.

• NSAIDs like ibuprofen (200-400mg every 4-6 hours) or diclofenac potassium can provide effective relief by reducing inflammation, but may cause gastrointestinal irritation, increased bleeding risk, and kidney problems with prolonged use.
• Aspirin (325mg every 4-6 hours) works similarly to NSAIDs but carries additional bleeding risks.
• For migraine headaches, triptans such as sumatriptan (25-100mg as needed) can be effective by constricting blood vessels and blocking pain pathways, though they may cause dizziness, chest tightness, and shouldn't be used in those with cardiovascular disease, as noted in 1 and 1.
• Combination medications like Excedrin (acetaminophen, aspirin, and caffeine) can be particularly effective for tension headaches but may increase side effect risks.
• Preventive medications might be necessary for severe or recurrent headaches, and any sudden, severe, or unusual headache patterns should prompt immediate medical attention, especially when accompanied by neurological symptoms, fever, or following head trauma. It's also important to consider the potential for medication-overuse headache and to educate patients about the control of acute attacks and preventive therapy, engaging them in the formulation of a management plan, as emphasized in 1 and 1. The use of triptans as second-line medication, and considering ditans and gepants as third-line medications, as recommended in 1, should be guided by the patient's response to initial treatment and their individual risk factors.

From the FDA Drug Label

Sumatriptan tablets can cause serious side effects, including: Heart attack and other heart problems. Sumatriptan tablets are not for people with risk factors for heart disease unless a heart exam is done and shows no problem You have a higher risk for heart disease if you: have high blood pressure have high cholesterol levels smoke are overweight have diabetes have a family history of heart disease Sumatriptan tablets can cause dizziness, weakness, or drowsiness If you have these symptoms, do not drive a car, use machinery, or do anything where you need to be alert. Sumatriptan tablets may cause serious side effects. These serious side effects include: changes in color or sensation in your fingers and toes (Raynaud’s syndrome) stomach and intestinal problems (gastrointestinal and colonic ischemic events)

Medications that can be given for headache:

• Sumatriptan tablets Side effects to be considered:
• Heart attack and other heart problems
• Changes in color or sensation in your fingers and toes (Raynaud’s syndrome)
• Stomach and intestinal problems (gastrointestinal and colonic ischemic events)
• Dizziness, weakness, or drowsiness Key considerations:
• Patients with risk factors for heart disease should undergo a heart exam before taking sumatriptan tablets
• Patients should be monitored for serious side effects, including heart problems and changes in color or sensation in their fingers and toes
• Patients should not drive or operate machinery if they experience dizziness, weakness, or drowsiness 2 2

From the Research

Medications for Headache

The following medications can be used to treat headaches:

• Acetaminophen: suitable for mild to moderate migraine attacks, and remains the first choice for children and pregnant women 3, 4, 5
• Nonsteroidal anti-inflammatory drugs (NSAIDs): such as aspirin, diclofenac, ibuprofen, and naproxen, are effective for mild to moderate migraines 3, 4, 5
• Triptans: such as sumatriptan, are effective for moderate to severe migraines, but may be expensive and have adverse effects such as transient flushing, tightness, or tingling in the upper body 3, 4, 5
• Antiemetics: can be used to alleviate nausea and vomiting 3, 4
• Ergot alkaloids: such as dihydroergotamine, can be used as second- or third-line therapy for select patients or for those with refractory migraine 3, 4
• Gepants: such as rimegepant or ubrogepant, can eliminate headache symptoms for 2 hours in 20% of patients, but have adverse effects of nausea and dry mouth in 1% to 4% of patients 5
• Lasmiditan: a 5-HT1F agonist, is also available for acute migraine treatment and appears safe in patients with cardiovascular risk factors 5

Side Effects to Consider

When using these medications, the following side effects should be considered:

• NSAIDs: gastrointestinal upset, renal impairment, and increased risk of bleeding 3, 4
• Triptans: transient flushing, tightness, or tingling in the upper body, and vasoconstrictive properties that may be harmful to patients with cardiovascular disease 3, 4, 5
• Gepants: nausea and dry mouth in 1% to 4% of patients 5
• Opiates: serious adverse events, and are not recommended for acute migraine treatment due to the risk of medication-overuse headache 3, 6

Treatment Approach

The treatment approach for headaches should be individualized based on the pattern and severity of attacks, and should follow the concept of "stratified care" 3, 4. This includes:

• Taking medication early in an attack
• Using a stratified treatment approach, with mild to moderate migraines treated with oral NSAIDs or acetaminophen, and moderate to severe migraines treated with triptans or ergot alkaloids
• Avoiding opioids due to their scarce effectiveness in the acute phase and risk of medication-overuse headache
• Referring patients to a Headache Center for further evaluation and management 6