Headache Medications are used in the following ways:

• Analgesic, or pain relief. Such agents include over-the-counter (OTC) remedies, such as aspirin, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naprosyn, which are used to relieve headache symptoms. Some analgesics require prescriptions and include other NSAIDS,  neuroleptics, and opioids.
• Abortive. These agents are used to reverse, abort or reduce headaches once they start. They include such medications as ergotamine and the newest class of abortives, the triptans, including sumatripan, rizatriptan, and naratriptan. These medications are most appropriate when used no more than two days a week to avoid the risk of rebound headaches or when prophylactic, or preventive, medicines either aren’t effective or can’t be used.
• Prophylactic, or preventive. These agents are prescribed when headaches occur more than twice a week and/or are extremely painful. They are also prescribed when other medications or remedies used to treat headache symptoms either don’t work or cannot be used. Such agents include beta-blockers, calcium channel blockers and serotonin antagonists.

Migraine Headache Medications

Abortive treatments for migraines are used at the first sign of a migraine and can stop the process that causes the headache pain after it has started. By stopping the headache process, these medications help prevent common symptoms of migraines such as pain, nausea, and sound and light sensitivity. Some medications should not be used during a migraine aura; please follow the instructions of your doctor.

The following medications are used to stop the migraine headache process:

Category	Generic Name	Brand Name	May be used during an aura?	Possible Side Effects
Over-the-counter	Ibuprofen	Motrin		Stomach upset
	Aspirin-Acetominophen-Caffeine	Excedrin Migraine, Excedrin, Goody’s		Heartburn Anxiety Insomnia Allergic reaction Liver Damage Blood in stool or vomit Dizziness Easy bruising
	Naproxen	Aleve		Gastrointestinal upset Gastrointestinal bleeding Nausea Vomiting Rash Liver damage
Ergot	dihydroergotamie	DHE-45 injection Migranal intranasal	Yes — as indicated for Migranal intranasal only	Nausea Numbness of fingers and toes
Vasoconstrictor Combination	acetaminophen isometheptene mucate dichloralphenazone	Midrin, Duradrin	Yes	Sedation Nausea
Triptans	sumatriptan succinate	Imitrex injection, oral or intranasal	No (injection) Yes (oral or intranasal)	Head, jaw, chest and arm discomfort, tightening or tingling Throat discomfort Muscle cramps Flushing
	zolmitriptan	Zomig	Yes	Head, jaw, chest, and arm discomfort, tightening or tingling Throat discomfort Muscle cramps Flushing
	rizatriptan	Maxalt	Yes	Head, jaw, chest, and arm discomfort, tightening or tingling Throat discomfort Muscle cramps Flushing
	naratriptan hydrochloride	Amerge	Yes	Head, jaw, chest, and arm discomfort, tightening or tingling Throat discomfort Muscle cramps Flushing
	almotriptan	Axert	Yes	Head, jaw, chest, and arm discomfort, tightening or tingling Throat discomfort Muscle cramps Flushing
	frovatriptan	Frova	No	Head, jaw, chest, and arm discomfort, tightening or tingling Throat discomfort Muscle cramps Flushing
	Eletriptan	Relpax	Yes	Chest tightness Dizziness Dry mouth Headache Nausea Numbness and tingling Sleepiness Jaw, throat discomfort

Tension-Type Headache Medications

Tension-type headaches may actually be a form of migraine headache, which means that many of the medications that work for migraines may work for these headaches as well. See migraine headache treatment. (Your treatment may vary depending upon your sensitivity to certain medications or therapy approaches or your health-care provider’s recommendations.) Following are medications commonly used for treatment of tension-type headaches:

Mild Non-narcotic Analgesics – Aspirin, acetaminophen, and the nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naprosyn.
Comments For mild headache, only. Daily use of aspirin and/or acetaminophen may lead to rebound headaches. Frequent use of aspirin and NSAIDs can lead to gastrointestinal bleeding and, in the case of aspirin, tinnitus (ear ringing).

 Mixed Analgesics, with and without Codeine – Includes acetaminophen/codeine and isometheptene (Midrin), a combination drug of isometheptene, acetaminophen, dichloralphenazone.
Comments: For mild to moderate tension-type headaches. Isometheptene should not be used if you have coronary artery disease, or with monoamine oxidase inhibitors. Daily use may lead to rebound headaches.

Tricyclic Antidepressants – Includes amitriptyline (Elavil), nortriptyline (Pamelor), Doxepin (Sinequan).
Comments: May cause dry mouth, blurry vision, urinary retention, constipation  or lightheadedness caused by lowering of blood pressure when suddenly arising, particularly in the elderly. Use with caution if you have heart disease.

Preventative Treatments

Calcium-Channel Blockers – Verapamil (Calan, Isoptin).
Comments: First choice treatment to prevent cluster headaches, although weeks of therapy may be required to control headaches. Agents may cause water retention, fatigue or constipation.

Corticosteroids – Prednisone, dexamethasone (Decadron).
Comments: While 80 percent to 90 percent reliable in preventing cluster headache attacks during active therapy, steroids are not appropriate for prolonged preventive therapy. Used regularly, they may cause side effects, including edema (water retention), hyperglycemia (elevated blood sugar), decreased wound healing, bone resorption and mood changes.

Daily Ergot Derivative Use – Ergotamine tartrate and Dihydroergotamine (DHE).
Comments:

• Daily use of ergotamine tartrates (ErgostatSL, Cafergot, Wigraine) is reserved for the most extreme and debilitating cases due to a high incidence of side effects, including rebound or chronic headaches. As a result, ergotamine use typically is limited to no more than two days per week.
• DHE is similar to ergotamine, but is not associated with rebound headaches.

The Triptans – Sumatriptan (Imitrex), Naratriptan (Amerge), Rizatriptan (Maxalt) and Zolmitriptan (Zomig).
Comments: For best results, use these medications soon after the headache begins. Triptans should not be used if you have coronary artery disease, heart disease, or with ergotamine migraine medication. They may cause flushing, tingling, warmth, numbness or tightness in the chest. Do not use in aura phase of migraine with aura.? Sumatriptan comes in pill and spray form.

Anticonvulsants – Valproic Acid (Depakote).
Comments: Recently approved by the FDA for migraine prevention, it may cause weight gain, nausea, vomiting, diarrhea and dizziness.? Warning: Cases of acute and fatal liver problems have been associated with Depakote use.

Daily Opioids
Comments: Reserved for extreme cases where all other reasonable treatments have failed or cannot be used to prevent cluster headaches.

Other Preventive Treatments – A number of other therapies have been used to prevent cluster headaches.? Among them are: lithium, methysergide/methylergonovine, divalproex sodium, and transdermal or oral clonidine.

Symptomatic Cluster Headache Medications/Therapies

Following are some medications and therapies commonly used to treat cluster headaches:

Oxygen Inhalation Therapy
Comments: Inhaling pure oxygen via a facemask is useful in alleviating headache symptoms, particularly when taken at the first sign of headache pain. Do not use if you have chronic obstructive pulmonary disease.

Dihydroergotamine (DHE)
Comments: Similar to ergotamine, DHE is not associated with rebound headaches. It is used as a preventive treatment as well.

The Triptans – Sumatriptan (Imitrex), Naratriptan (Amerge), Rizatriptan (Maxalt) and Zolmitriptan (Zomig).
Comments: For best results, use these medications soon after the headache begins. Use early in the course of the headache for best results. Triptans should not be used if you have coronary artery disease, heart disease or with ergotamine medications. They may cause flushing, tingling, warmth, numbness or tightness in the chest. Sumatriptan comes in pill and spray form.

Lidocaine
Comments:? A nasal spray, it results in rapid relief of migraine and lasts 10-15 minutes. Headache relapse may occur.

Neuroleptics – Used for symptomatic relief of headache pain and to treat headache-induced nausea and vomiting. These include metoclopramide (Reglan);
phenothiazines: chlorpromazine (Thorazine), prochlorperazine (Compazine), perphenazine (Trilafon), promethezine (Phenergan), and Trimethobenzamide (Tigan); and
butyrophenones: haloperidol (Haldol) and droperidol (Inapsine).
Comments: Possible side effects include sleepiness, confusion and low blood pressure.? Prolonged regular use can lead to neurological disorders such as Pparkinsonism and tardive dyskinesia.

Opioids – Rectal or nasal sprays.
Comments Avoid frequent use.

Other Symptomatic Cluster Headache Treatments – A number of other drugs have been used to treat the symptoms of cluster headaches. Among them are capsaicin and indomethacin (Midrin).

“Ordinary” Headache Medications

Following are some medications commonly used to treat so-called “ordinary” headaches:

Mild Non-narcotic Analgesics – aspirin, acetaminophen, and the nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naprosyn.
Comments:? For mild headache, only. Daily use of aspirin and acetaminophen may lead to rebound headaches. Frequent use of aspirin and NSAIDs can lead to gastrointestinal bleeding and, in the case of aspirin, and/ or acctominophen may leat to reboun headaches and tinnitus (ear ringing).

Secondary Headaches Medications

Post-Traumatic Headache Treatment

Treatment of post-traumatic headaches requires a comprehensive, multidisciplinary approach.? In most cases, patients are treated according to specific headache patterns. See migraine headache treatment and tension headache treatment for specific treatments.?

Reactive Headache Treatment

Reactive headaches can be caused by virtually hundreds of external factors. Perhaps the best solution for reactive headache sufferers is to identify and, if possible, avoid or eliminate whatever triggers the headache. A visit to your physician to rule out the more serious causes of reactive headaches is the first step in treating such headaches.? For example, headaches caused by seasonal allergies typically respond to antihistamine medications, topical nasal cortisone and related sprays or desensitization injections used to treat various types of allergies.

Rebound Headache Treatment

Rebound headaches are caused by medication withdrawal following frequent or excessive use of headache pain medications. Treatment typically focuses on detoxification — slowly tapering medications — and on easing side effects, such as nausea.? While the headaches may intensify for a few days following medication withdrawal, rebound headaches usually disappear after three to five days.? Preventive medications are not effective in treating rebound headache until medication withdrawal is complete, which in more severe cases may require hospitalization.? While this detoxification process may eliminate the rebound headache, the original headache (such as migraine, tension-type or cluster) that prompted the overuse of pain medications may still be present following withdrawal. Following are some medications commonly used to treat rebound headaches:

Nonsteroidal Anti-Inflammatory Drugs (NASIDs) – Includes Ibuprofen and Naprosyn.
Comments Unlike many other pain-relieving medications, NSAIDs do not cause rebound headaches. Taking small doses may help ease pain during medication withdrawal.

Neuroleptics – Chlorpromazine (Thorazine) or Prochlorperazine (Compazine).
Comments Such drugs are used to treat medication withdrawal symptoms such as nausea and vomiting, which are a major side effect of ergotamine withdrawal.

Sinus Headache Medications

Acute or chronic sinusitis, or sinus infections, can cause headaches or trigger pre-existing headache conditions, such as migraines.? Because sinus headaches are among the most misdiagnosed headache conditions, a thorough medical examination is needed to make sure you are, indeed, suffering from a sinus infection-related headache. Headaches caused by acute sinusitis typically are relieved when the sinus infections are cleared up using oral antibiotics. Chronic, or recurring sinus infections may require intravenous antibiotics or surgically draining the sinus cavity, which in turn should relieve your headache.

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