How Are Headaches Treated?
Medically reviewed by Smita Patel, DO
Headache treatments often include a dose of Bayer (aspirin) or Advil (ibuprofen). Other headaches need a more comprehensive treatment plan, especially when they occur as part of a chronic headache condition.
The first step to swiftly and successfully treating any headache is knowing what type you're dealing with. Different types of headaches require different treatments. Whatever type of headache you have, the ideal treatment involves a combination of relieving symptoms (especially pain), preventing future headaches, and reducing the overall number of headache episodes you have.
A neurologist (a healthcare provider specializing in treating conditions of the brain and spinal cord) can figure out what type of headache you have and how best to manage them so they interfere with your daily life as little as possible. This might mean taking medication, making specific lifestyle changes, and avoiding triggers.
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Treatments by Condition Type
There are three main types of headache disorders: migraine, tension-type headache (TTH), and cluster headache. These are all considered primary headache disorders. This means there's no underlying cause, such as another health condition, causing them. Primary headache disorders are the most common disability in the world.
It's important to know what type of primary headache disorder you have. Different headache conditions respond differently to common types of treatments. Identifying whether your headaches are migraine, TTH, cluster, or something else will make it easier for you to treat and prevent them.
There is no cure for migraine or cluster headaches. Some strategies can reduce the number of headaches you have each month. TTHs can sometimes be eliminated by addressing the root cause—for example, if insomnia or depression is triggering headaches. TTHs can become chronic and may not have an obvious cause that you can treat.
Treatments for Migraine Headache
Migraine is a neurological condition that affects about 12% of people. This headache disorder is more than just a "bad headache." Migraine causes episodes of intense, stabbing head pain, nausea, vomiting, and environmental sensitivity to lights, smells, and sounds.
You have episodic migraine if you have fewer than 15 headache days per month. You have chronic migraine if you have 15 or more headache days per month. This distinction can determine what drugs and treatments are available to you.
Some people experience something known as an aura, or a visual warning sign, before a migraine happens. Many people with migraine do not experience an aura. Migraine treatments usually include a two-pronged approach: acute treatments to treat existing symptoms and preventive treatments to reduce the number of episodes.
Acute treatments for migraine include:
Anti-nausea medications: A healthcare provider may prescribe these if you feel nauseated or vomit with a migraine.
CGRP antagonists: These are a newer class of migraine drugs that block a specific protein, calcitonin gene-related peptide (CGRP), from being triggered. CGRP is associated with the brain's pain response signals. Nurtec (rimegepant) is a CGRP antagonist, which you can take during a migraine to stop pain and inflammation.
Pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and oral analgesics like Tylenol (acetaminophen), treat acute migraine headaches. Combination pain relievers, such as those containing aspirin, acetaminophen, and caffeine, can be efficacious. Prolonged use can lead to gastrointestinal (GI) or liver problems and medication-overuse headaches.
Triptans: This class of medication targets the cause of migraine. There are several types of triptans available for getting rid of a migraine. These drugs are usually only recommended for use up to nine days per month. Triptans are meant to be used as soon as migraine symptoms appear. You may develop side effects like dizziness, fogginess, and fatigue, so some people do not find them helpful.
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Treatments for preventing migraine include:
Anticonvulsants: Some people find anti-epilepsy drugs like Topamax (topiramate) to relieve symptoms when other treatments fail to prevent migraine. Many people don't tolerate Topamax well. The drug can cause nausea and loss of appetite, weight loss, and even cognitive confusion.
Antidepressants: Tricyclic antidepressants can affect the number and severity of migraine episodes. Research has shown that Elavil (amitriptyline), in particular, is one of the most effective antidepressants that reduce migraines.
Beta-blockers: Blood pressure medications, especially Inderal LA (propranolol), can reduce the number of migraine episodes per month.
Botulinum toxin (Botox) injections: You may be a candidate for Botox injections if you have chronic migraine and prescription drugs have not reduced the number of migraines. This somewhat unconventional treatment can reduce the number of migraines per month. Not everyone is comfortable with the idea of facial injections. Insurance doesn't always cover the procedure, even when being used medically.
CGRP antagonists: Many preventive CGRP antagonists are available as a monthly injection. These inglude Emgality (galcanezumab) and Aimovig (erenumab). CGRP antagonists are fairly new but generally have a low incidence of side effects. You may also use Nurtec preventively and acutely.
Lifestyle changes: Many migraine episodes are triggered by something in your environment. Triggers can include a weather change, certain food or drinks, noises or smells, or a disruption to your sleep schedule. Identifying triggers and doing what you can to avoid them can decrease the number of migraine episodes overall.
Treatments for Tension-Type Headache
The treatment for tension-type headaches (TTH) usually depends on how frequent your headaches are. Episodic TTH is common. You've probably had one if you've ever had a stressful afternoon or lost a night of sleep and then developed pain that felt like a band wrapped tightly around your head. You can treat most of these headaches with over-the-counter (OTC) pain relievers like Bayer, Advil, or Tylenol.
Some people, however, have TTH more often. You may have chronic TTH if you have 15 or more days per month with TTH for three or more months.
Chronic TTH requires a more comprehensive treatment plan, which includes:
Pain relievers: The same types of pain relievers that treat migraine can relieve TTH symptoms. Not everyone is a candidate for some of these drugs, and overuse can lead to other health problems. Experts recommend that you take these drugs no more than two to three times per week to avoid complications.
Antidepressants: Some evidence suggests that certain antidepressants, like Elavil and Effexor (venlafaxine), may reduce TTH frequency.
Treatments for Cluster Headache
Cluster headaches belong to a group of headache disorders called trigeminal autonomic cephalalgias (TACs). Other types of headaches in this category include paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua. Cluster headaches are the most common within this grouping.
Cluster headaches cause excruciating pain that typically comes on suddenly and lasts a shorter time than migraine and TTH. These headaches are usually debilitating, and the cause is relatively unknown. There are both acute and preventive treatments.
Acute treatments for cluster headaches include:
Intranasal and injection: Lidocaine nasal spray can help relieve symptoms if you use it early on in an episode. A similar drug called Migranal (dihydroergotamine) can be injected or used intranasally. Injection generally works better than intranasal and carries less risk of side effects.
Oxygen: This is a safe and effective, though somewhat inaccessible, treatment. Oxygen supplementation can stop a cluster headache, but experts are not entirely sure why. Most people need to go to a healthcare provider's office or an urgent care facility to receive it.
Triptans: Triptans are often taken orally. These drugs can also be injected or sprayed intranasally to provide fairly quick relief from cluster headaches.
Treatments for preventing cluster headaches include:
Anticonvulsants: Drugs like Topamax may prevent cluster headaches, but it's not a first-line treatment. A healthcare provider usually prescribes anticonvulsants if other treatments don't have any effect.
Calcium channel blockers: Many primary headache disorders include calcium channel or beta blockers as preventive treatments. Cluster headaches are no different, but they often benefit from one specific drug more than others: Verelan (verapamil). This drug can lower heart rate and blood pressure, so not everyone is a candidate for it.
Lithium: Some people may benefit from using lithium to prevent cluster headaches. Long-term use of the drug can cause problems with the liver, kidneys, and thyroid, so it may not be an option for everyone.
Steroids: Corticosteroids seem to be an effective way to stop ongoing cluster headache attacks if you use them as a short-term treatment (i.e., for a few weeks). Taking corticosteroids long-term can lead to other health problems, such as an increased infection risk.
Treatments for Other Primary Headache Disorders
Some recurring headaches not caused by other health conditions don't fall under the migraine, TTH, or cluster headache categories. These include disorders like primary cough headache, primary exercise headache, primary thunderclap headache, cold-stimulus headache, hypnic headache, and new daily persistent headache. Treatments for these headaches vary by type.
There are some common strategies if you have one of these primary headache disorders, including:
Calcium channel or beta blockers: Drugs like Nimotop (nimodipine) and Inderal LA may be effective preventive treatments for some of these headaches. These drugs may reduce the inflammatory response that can cause some primary headache disorders, such as thunderclap headaches and primary exercise headaches.
NSAIDs: Certain types of NSAIDs, especially Indocin (indomethacin), may treat these headaches. Some NSAIDs can possibly prevent headaches if you use them before they occur, like in the case of primary exercise headaches. Indomethacin is a first-line treatment for primary cough headaches and thunderclap headaches.
Some migraine drugs: Common migraine and TTH treatments may prevent or reduce hypnic headaches and new daily persistent headaches. These include such as Elavil, Topamax, and combination analgesic/caffeine drugs.
Living With and Managing Headaches
Many types of primary headache disorders can cause symptoms severe enough to interfere with your daily life. The good news is that these headaches are typically not life-threatening. There are no cures for any of the primary headache disorders. Several treatment options—both acute and preventive—for each category can make it easier to live with headaches.
You may be able to identify the root cause of your headaches and greatly reduce the number of you experience in some cases, like migraine and TTH. There are other ways to cope with and learn to manage your condition, such as:
Finding a therapist or other alternative treatment providers (e.g., acupuncturists) who can provide you with coping mechanisms, tips for talking to people about your condition, and stress-reducing strategies
Joining a local or online support group for people with your type of headache condition
Keeping a headache diary to help track your symptoms, find patterns, and improve your treatment plan
Learning your triggers so you can avoid as many headaches as possible
Letting family, friends, and co-workers know of your condition so they can assist you when you have an episode
It's important to work with a neurologist or headache-knowledgeable healthcare provider to develop a treatment plan to manage your headaches. New treatments are frequently being made available to people with chronic headaches. A headache specialist will be able to inform you of these advances and help you decide what ones might be helpful.
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A Quick Review
There are three main types of primary headache disorders—migraine, TTH, and cluster headache—as well as several other types that don't fall into these categories. Several types of treatments are available to reduce symptoms and prevent or reduce the number of future headaches. It's important to know what type of primary headache disorder you have so you can find the best treatment.
A neurologist or headache specialist can help determine your diagnosis and identify potential triggers or root causes. They can work with you to make a treatment plan that helps stop a headache once it starts and have fewer headaches in the future.
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