Medicine for headache
Reading File
Finding Sources
Finding Sources
Reading File
Reading File
Reading File
Here is a comprehensive overview of medicines used for headache, organized by headache type:
Medicines for Headache
1. Tension-Type Headache (Most Common)
First-line (OTC analgesics):
| Drug | Dose |
|---|---|
| Acetaminophen (Paracetamol) | 650–1000 mg |
| Aspirin | 250–1000 mg |
| Ibuprofen | 200–800 mg (first choice; lowest GI risk) |
| Naproxen sodium | 220–500 mg |
| Diclofenac | 50 mg |
- Simple analgesics work well for episodic (occasional) tension headaches.
- Persistent or frequent tension headaches may require cautious use of tricyclic antidepressants (e.g., amitriptyline) for prevention.
— Adams and Victor's Principles of Neurology, 12th Ed. | Goldman-Cecil Medicine | Kaplan & Sadock's
2. Migraine Headache
Mild attacks (OTC):
- Acetaminophen (650–1000 mg) ± caffeine
- NSAIDs: Ibuprofen (400–800 mg), Naproxen sodium, Aspirin
Moderate-to-severe attacks (prescription):
| Drug | Route | Notes |
|---|---|---|
| Triptans (e.g., Sumatriptan) | Oral / SC / intranasal | First-line specific therapy; avoid in ischemic heart disease, uncontrolled HTN |
| Dihydroergotamine (DHE) | IV/IM | Pretreat with antiemetic; avoid in pregnancy, IHD |
| Ketorolac | IV/IM 10–30 mg | Good for acute ED management |
Antiemetics (also treat headache pain):
| Drug | Dose/Route |
|---|---|
| Prochlorperazine | 5–10 mg IV/PR |
| Metoclopramide | 10 mg IV |
| Droperidol | 2.5 mg IV/IM |
| Chlorpromazine | 7.5 mg IV |
Rescue/adjunct:
- Dexamethasone 6–10 mg IV — reduces headache recurrence
- Valproate 500 mg IV
- Magnesium sulfate 2 g IV over 30 min
- Methylprednisolone 125 mg IV/IM
Prevention (when migraines are frequent/severe):
- Beta-blockers (propranolol), tricyclics, valproate, topiramate
- CGRP monoclonal antibodies (e.g., erenumab, fremanezumab) — newer; reserved for patients who fail 2–3 other medication classes
— Tintinalli's Emergency Medicine | Goldman-Cecil Medicine | Adams and Victor's Neurology
3. Cluster Headache
Acute attack (abort):
- 100% Oxygen via mask for 10–15 min — very effective
- Sumatriptan or Zolmitriptan (SC or intranasal)
- Intranasal lidocaine
- Ergotamine 2 mg orally (anticipatory dose at bedtime)
Prevention:
| Drug | Dose | Notes |
|---|---|---|
| Verapamil | Up to 480 mg/day | First-line preventive; ECG monitoring recommended |
| Lithium | 600–900 mg/day | Effective in chronic cluster; watch for toxicity |
| Prednisone | 75 mg/day, tapering | Short course; quickly effective |
| CGRP antibodies | SC injection | Reduces frequency ~50% |
— Adams and Victor's Principles of Neurology, 12th Ed.
Key Warnings
- Medication overuse headache (MOH): Using analgesics or triptans too frequently (>10–15 days/month) can paradoxically cause chronic daily headache. Limit OTC analgesic use.
- Triptans: Contraindicated in ischemic heart disease, stroke history, uncontrolled hypertension.
- Ergotamine/DHE: Contraindicated in pregnancy, basilar/hemiplegic migraine, IHD.
- Red flags requiring urgent evaluation: sudden "thunderclap" headache, headache with fever/stiff neck, new headache after age 50, headache with neurological deficits → seek CT/MRI.
In summary, for most everyday headaches, ibuprofen or acetaminophen are the go-to options. For migraines, triptans are the most effective specific treatment. For cluster headaches, high-flow oxygen + triptans are first-line.
This is a shared conversation. Sign in to Orris to start your own chat.