Headache treatment

Approaching treatment

In order to devise a treatment plan for your patient, first you must help your patient set goals for treatment. There are three reasonable goals for a treatment plan for your patient with headaches:

1. To reduce use of abortive treatments and increase their efficacy
2. To reduce headache disability
3. To establish pain control and lower stress

The patient may indicate a preference for pharmacological or non-pharmacological therapy. You may find many patients are not receptive to prescription drugs and become overwhelmed by potential side effects, preferring instead to at least try remedies that they consider more natural. These may be supplements and / or lifestyle alteration.

If your patient does not wish to try a pharmaceutical intervention, there are many non-pharmacologic treatments such as:

• Get adequate sleep
• Practice yoga / meditation
• Attend therapeutic massage treatments
• Use essential oils such as peppermint oil
• Exercise
• Wear sunglasses

NOTE:

Medication overuse headaches

When taken in excess, overuse of a medication can increase the duration, severity, and frequency of the headache, thus transforming an episodic headache into chronic daily headache. This is called a transformed migraine.

All headache subtypes can be intensified by the overuse of medication

The mechanism is medication tolerance, which is a diminished response to a drug, when the drug is used repeatedly, and the body adapts to the continued presence of the drug.

Patients with transformed migraine often overuse analgesics, decongestants, triptans, ergotamines, muscle relaxants, and over-the-counter remedies to get relief, and then need more of that drug more frequently.

Although there is some controversy, it seems Fioricet (combination of acetaminophen, butalbital, and caffeine) and Amidrine (acetaminophen, dichloralphenazone and isometheptene) can also become overused with time if their use is not monitored. Some neurologists claim that overuse of nonsteroidal anti-inflammatory drugs can cause medication overuse headache, but many others contend that this is rare.

References

• The International Classification of Headache Disorders 3rd edition
• Rizzoli PB. Acute and preventive treatment of migraine. Continuum (Minneap Minn). 2012 Aug;18(4):764-82
• Mauskop A. Nonmedication, alternative, and complementary treatments for migraine. Continuum (Minneap Minn). 2012 Aug;18(4):796-806.
• Parikh SK, Silberstein SD. Calcitonin gene-related peptide monoclonal antibodies. Practical Neurology. 2018; 17: 20–22.
• Tepper SJ, Tepper DE. Neuromodulation and headache. Practical Neurology. 2018; 17: 42–45. 
• Natekar A, Malya S, Yuan H, Nahas S. Migraine Preventative Therapies in Development. Practical Neurology. 2018; 17: 54–57.
• Blumenfeld AM. Botox for chronic migraine: Tips and tricks. Practical Neurology. 2018; 17: 27–36
• Halker Singh RB, Starling AJ, VanderPluym J. Migraine acute therapies. Practical Neurology. 2019; 17: 63–67
• Krel R, Mathew PG. Procedural treatments for headache disorders. Practical Neurology. 2019; 17: 76–79.
• Motwani M, Kuruvilla D. 2019. Behavioral and integrative therapies for headache. Practical Neurology. 2019; 17: 85–89

Neurology Library: Headache – Treatment

• Coni R. Headache treatment. LITFL
• Coni R. Headache treatment: Prophylactic medication. LITFL
• Coni R. Headache treatment: Prophylactic medication (2). LITFL
• Coni R. Headache treatment: Abortive medication. LITFL
• Coni R. Headache treatment: Rescue medication. LITFL
• Coni R. Headache: Diagnostic challenge. LITFL