Treatment of Headache

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Firstly, it must be known what type of headache the patient has. Secondly, if there are any triggers, such as a change in sleep pattern or the taking of any food or drug, they must be identified and controlled. Healthy life habits have to be promoted, like maintaining regular sleeping hours, exercising, avoiding tobacco and alcohol, a balanced diet and avoiding constipation. And thirdly, a prescription for the treatment of acute attacks of pain should be given.

For migraine it is very important to start the acute treatment as near as possible to the onset of the appearance of the headache. Non-steroidal anti-inflammatory drugs with a rapid gastric absorption or triptans are used.

For tension headaches the use of relaxation techniques is chosen, along with exercise, anxiolytics, or paracetamol. In hemicranial headache indomethacin is prescribed, and in cluster headaches, subcutaneous sumatriptan or intranasal zolmotriptan.

In any case, it must be taken into account if the patient, despite following the previous prescriptions, is a candidate to receive continuous or preventive prophylaxis treatment in order to reduce the number of episodes and their intensity and to prevent the headache from becoming chronic. 

50% of patients with <a href="/en/assistance/be-healthy/headache">headache</a> self-medicate, which often leads to the pain becoming chronic.

Treatment of Migraine

Treatment of a migraine attack.

The pain produced by the migraine has to be treated at the time it starts, that is to say, as soon as possible. Mild to moderate attacks are treated with anti-inflammatory drugs, and if there is no response, with triptans. Moderate to severe attacks are also treated with triptans, and if there is no response or it is insufficient, an anti-inflammatory drug may be added. The efficacy of each pharmacological group is supported in scientific studies that include the highest level of evidence (A) for the majority of them.

On the other hand, it is necessary to avoid the abuse of drugs, since it is one of the factors that can lead to the migraine becoming chronic. By abuse, it is understood the consumption of more than 10 anti-inflammatory drugs or more than 15 triptan drugs a month.

Preventive treatment

In general, preventive treatment is indicated when:

  • there are three or more migraine attacks a month,
  • if a symptomatic treatment is being taken two or more days per week,
  • if the attacks are severe with no adequate response to the treatment or with contra-indications or secondary effects to them,
  • if the attacks are with a prolonged aura or with a severe neurological focus.

The choice of one or other drug does not only depend on its efficacy, since there are no large differences between them, but on the patient’s profile, individualising the treatment depending on the possible secondary effects that they may cause; avoid increasing weight in females, impotence in males, making any depressive symptoms worse, etc.

As regards preventive treatment, in order to be effective, it has to last a minimum of between 3 and 6 months, and the optimum dose should be reached before rejecting it. There is a delay time between when it is started until it is effective that can vary between 10 days and 4 weeks. The treatment is considered effective when the frequency or intensity of the headache days is reduced by 50%. Once it is decided to withdraw it, it must be done slowly and gradually (1 month) and, in cases of refractory migraine, the doctor may recommend combining drugs.

The treatment is considered effective when the frequency or intensity of the <a href="/en/assistance/be-healthy/headache">headache</a> days is reduced by 50%.

New treatments

In this section new treatments are described that, due to their complexity or elevated cost, are administered exclusively in specific Headache Units.

Substantiated information by:

Neus Fabregat i Fabra
Víctor Obach Baurier

Published: 16 May 2018
Updated: 16 May 2018

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