Medicine for headache
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Here is a structured overview of medicines for headache, organized by headache type, based on authoritative medical textbooks.
Medicines for Headache
Headache treatment depends on the type of headache. The three most common types are tension-type, migraine, and cluster headache.
1. Tension-Type Headache (Most Common)
These are the first-line drugs for the typical dull, pressure-like, bilateral headache:
| Drug | Notes |
|---|---|
| Paracetamol (Acetaminophen) | First choice; well-tolerated |
| Aspirin | Effective OTC option |
| Ibuprofen / Naproxen | NSAIDs; good for mild-to-moderate pain |
| Caffeine combinations | Caffeine aids absorption, helps vasoconstriction |
Warning: Avoid taking analgesics more than 10-15 days/month. Overuse of paracetamol, NSAIDs, opioids, or triptans can cause medication overuse (rebound) headache - a chronic daily headache pattern. - Bradley and Daroff's Neurology in Clinical Practice
2. Migraine Headache
Treatment is split into non-specific (analgesics) and migraine-specific drugs. Start treatment as early as possible - ideally during the aura, before pain begins.
Non-Specific (Mild-Moderate Attacks)
| Drug | Dose | Notes |
|---|---|---|
| Aspirin | Oral | Effective for mild attacks |
| Acetaminophen | Oral | With or without caffeine |
| Ibuprofen | Oral | Common first-line NSAID |
| Naproxen | Oral | Longer-acting NSAID |
| Ketorolac | 10-30 mg IV/IM | For ED/severe attacks |
Migraine-Specific (Moderate-Severe Attacks)
| Drug | Dose | Notes |
|---|---|---|
| Sumatriptan | 6 mg SC (or oral/intranasal) | First-line triptan; selective 5-HT1 agonist |
| Zolmitriptan | Oral/nasal | Alternative triptan |
| Dihydroergotamine (DHE) | 1 mg IV | Avoid in pregnancy; pretreat with antiemetic |
| Lasmiditan | Oral | Newer 5-HT1F agonist; no vasoconstrictive effects; comparable to triptans |
Triptans are more effective than simple analgesics, especially for disabling migraines. They work best taken early. - Bradley and Daroff's Neurology in Clinical Practice
Contraindications for triptans/DHE: ischemic heart disease, uncontrolled hypertension, basilar or hemiplegic migraine.
For Nausea/Vomiting (Adjuncts)
| Drug | Dose | Notes |
|---|---|---|
| Metoclopramide | 10 mg IV | Antiemetic; also speeds gastric absorption |
| Prochlorperazine | 5-10 mg IV/PR | Antiemetic; give diphenhydramine concurrently |
| Droperidol | 2.5 mg IV/IM | Monitor QT interval |
| Dexamethasone | 6-10 mg IV | Adjunct to reduce recurrence |
(Source: Tintinalli's Emergency Medicine)
3. Cluster Headache (Severe, Unilateral, Periorbital)
| Drug | Notes |
|---|---|
| 100% Oxygen (inhaled) | 10-15 min via mask at attack onset; first choice |
| Sumatriptan SC | Aborts acute attack |
| Intranasal lidocaine | Acute abort |
| Ergotamine | 2 mg orally; anticipatory dosing at bedtime |
| Verapamil | Prevention; 80 mg QID up to 480 mg/day |
| Lithium | 600-900 mg/day; for chronic cluster |
| Prednisone | 75 mg/day tapering over days; short-term prevention |
| Anti-CGRP monoclonal antibodies | Newer agents; reduce episode frequency by ~50% |
(Source: Adams and Victor's Principles of Neurology, 12th Ed.)
Key Principle: Stratified vs. Step-Care
A randomized trial showed that stratified care (choosing medication based on attack severity from the start) gives better outcomes than always starting with an NSAID and stepping up - better headache response, less disability, lower cost. - Bradley and Daroff's Neurology in Clinical Practice
Disclaimer: These are general educational guidelines. Always consult a doctor or pharmacist before starting any medication, especially for recurrent or severe headaches, to rule out secondary causes.
Medicines for half side headache in left side
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A one-sided (left-sided) headache is the hallmark of migraine. Here is a complete medicine guide based on Bradley and Daroff's Neurology in Clinical Practice and Tintinalli's Emergency Medicine:
Medicines for One-Sided (Migraine) Headache
What Is It?
A headache on one side - throbbing, sometimes with nausea, light/sound sensitivity, or visual aura - is classic migraine. The side can vary between attacks or stay on the same side.
PART 1 - Medicines to STOP an Attack (Acute/Abortive Treatment)
Take these as early as possible when the headache starts - or even during the aura before pain begins.
Step 1 - Mild to Moderate Pain: Simple Analgesics (OTC)
| Medicine | Dose | Notes |
|---|---|---|
| Ibuprofen | 200-400 mg | Most commonly used NSAID for migraine |
| Aspirin | 500-1000 mg | Good first-line choice |
| Paracetamol (Acetaminophen) | 1000 mg | Milder; combine with caffeine for better effect |
| Naproxen sodium | 550 mg | Longer-acting NSAID |
| Diclofenac potassium | 50-100 mg | Effective NSAID option |
| Paracetamol + Aspirin + Caffeine | 500/500/130 mg | Combination; caffeine boosts effect |
Step 2 - Moderate to Severe Pain: Triptans (Most Effective)
Triptans are migraine-specific - they target the exact brain pathways that cause migraine. They work by activating 5-HT1B/1D receptors, constricting cranial vessels and blocking pain signals from the trigeminal nerve.
| Triptan | Route | Dose | Max per 24h |
|---|---|---|---|
| Sumatriptan | SC injection | 6 mg | 12 mg |
| Sumatriptan | Oral | 50-100 mg | 200 mg |
| Sumatriptan | Nasal spray | 10-20 mg | 40 mg |
| Almotriptan | Oral | 6.25-12.5 mg | 25 mg |
| Rizatriptan | Oral | 5-10 mg | 30 mg |
| Zolmitriptan | Oral/Nasal | 2.5-5 mg | 10 mg |
| Eletriptan | Oral | 20-40 mg | 80 mg |
| Naratriptan | Oral | 1-2.5 mg | 5 mg |
| Frovatriptan | Oral | 2.5 mg | 7.5 mg |
Subcutaneous sumatriptan gives the fastest and strongest relief. Oral forms are cheaper and more convenient.
Contraindications for triptans: ischemic heart disease, uncontrolled high blood pressure, history of stroke, basilar or hemiplegic migraine.
Step 3 - Newer Alternative: Lasmiditan
- Lasmiditan (oral) - a selective 5-HT1F agonist with NO vasoconstrictive properties
- Comparable efficacy to triptans
- Safer for patients with heart disease (unlike triptans)
- Can cause dizziness/drowsiness - do not drive for 8 hours after taking
Step 4 - If Nausea/Vomiting Present (Add These)
When vomiting is present, oral tablets are poorly absorbed. Use non-oral routes and add an antiemetic:
| Medicine | Dose | Notes |
|---|---|---|
| Metoclopramide | 10 mg IV | Antiemetic + speeds stomach absorption |
| Prochlorperazine | 5-10 mg IV/suppository | Strong antiemetic; give with diphenhydramine |
| Domperidone | Oral | Helps nausea and improves drug absorption |
| Dexamethasone | 6-10 mg IV | Adjunct to reduce headache recurrence |
Step 5 - Ergotamine (Older Alternative)
| Medicine | Notes |
|---|---|
| Dihydroergotamine (DHE) | 0.5-1 mg IV/IM/SC; very effective; pretreat with antiemetic |
| Ergotamine | Oral/suppository; less used now due to side effects |
Avoid if pregnant, heart disease, or used sumatriptan in the last 24 hours.
PART 2 - Medicines to PREVENT Attacks (Prophylaxis)
Consider prevention if you get 4+ migraine days per month, or if attacks are very debilitating. These medicines are taken daily even when you have no headache.
| Category | Drug | Dose |
|---|---|---|
| Beta-blockers (1st line) | Propranolol | 80-240 mg/day |
| Metoprolol, Timolol, Nadolol | Similar benefit | |
| Anticonvulsants (1st line) | Topiramate | Titrated up |
| Divalproex/Valproate | Titrated up | |
| Antidepressants | Amitriptyline | Low dose (independent of antidepressant effect) |
| Calcium channel blockers | Verapamil | 80-160 mg 3x/day (mainly migraine with aura) |
| Flunarizine | Effective in clinical trials | |
| Anti-CGRP antibodies (newest) | Erenumab, Fremanezumab, Galcanezumab | Monthly/quarterly injection; ~50% reduction in attack frequency |
Preventive treatment should be continued for at least 6-12 months after stabilization. Full benefit may take up to 6 months to appear. - Bradley and Daroff's Neurology in Clinical Practice
Important Warning: Medication Overuse Headache
Taking any painkiller (NSAIDs, paracetamol, triptans, opioids) more than 10-15 days per month can actually cause a chronic daily headache called medication overuse (rebound) headache. This is a very common trap - the medicine that helps your headache ends up causing more headaches if used too frequently.
Important: Always see a doctor if your headache is sudden/severe ("thunderclap"), comes with fever/stiff neck, vision changes, weakness, or is new and progressively worsening - these may signal something serious beyond migraine.
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