Headache pain may need to be managed with medications.
Medications used to treat headache pain can be grouped into three different types:
- Symptomatic relief
- Abortive therapy
- Preventive therapy
Each type of medication is most effective when used in
combination with other recommendations, such as dietary modifications, lifestyle
changes (at least 8 hours of sleep and adequate hydration [6 to 8 glasses of
water/day], exercise and relaxation therapy).
Symptomatic relief
This group of medications is given for the relief of symptoms
associated with headache. This includes the pain associated with headaches or
the nausea and vomiting associated with migraine headaches. Many of the
medications are available over-the-counter (without a prescription). Other
medications require a prescription from your doctor. When taking these
medications, avoid caffeine-containing foods and beverages and medications.
Medications containing barbiturates (butalbital) or narcotics (codeine) should
be avoided if possible. The use of aspirin should be avoided. Many of the
medications listed for symptomatic relief are not recommended for use in young
children (see end of document for discussion of ‘off-label’ use).
Abortive Therapy
These medications are used early in a migraine headache to stop
the process that causes the headache pain. In this way, they help minimize the
symptoms of headache, such as nausea/vomiting, and sound and light sensitivity.
These medications are most effective if used at the first sign of a migraine.
Some medications should not be used during a migraine aura; please follow the
instructions of your doctor.
When headaches -- and especially migraine headaches last longer
than 24 hours and other medications have been unsuccessful in managing the
attacks, medication administered in an "infusion suite" can be
considered. An infusion suite is a designated set of rooms at a hospital or
clinic that are monitored by a nurse and where intravenous drugs are
administered. The intravenous drugs are usually able to end the migraine attack.
Patients’ length of stay at the infusion suite can range from a several hours to all day.
Use of abortive therapies has not been approved for children (see end of document for discussion of ‘off-label’ use).
Overmedicating and Rebound Headache
People who are prone to having headaches may develop a pattern
of daily or almost-daily headaches. In some people, migraine-type headache
attacks may become so frequent that they finally blend together with no
clear-cut beginning or end. In both of these cases, the development of more
severe or more frequent headaches may actually be caused from taking headache
relief medications too frequently. Daily or almost daily use of over-the-counter
medications such as aspirin, acetaminophen, ibuprofen, narcotics, barbiturates
and caffeine-containing medications; or prescription medications such as the
triptans, appears to interfere with the brain centers that regulate the flow of
pain messages to the nervous system and may make your headache worse. In
addition, overmedicating interferes with the effectiveness of prescribed
preventive medications.
Rebound headaches may result from taking prescription or
nonprescription pain relievers daily or almost every day. If prescription or
nonprescription pain relievers are overused, the headaches may rebound as the
last dose wears off, leading you to take more and more medication and actually
aggravate the pain. When the medications are no longer taken, headache pain will
likely improve over a period of 6 to 12 weeks.
Preventive therapy
These medications are taken daily to prevent headaches. Some of
these medications are used for other medical conditions and were accidentally
discovered to help headache. While none of these medications cures headache,
preventive medications may reduce the frequency, duration, and severity of
headache attacks.
The medications listed include both over-the-counter and
prescription drugs. These drugs are not habit-forming, but any medication can
cause unwanted side effects. Your doctor will work with you to carefully
regulate the dosage so that side effects are minimized and headache relief is maximized.
To be effective, all preventive medications must be taken one or
more times every day. It may be necessary to change the medications and modify
their dosages in order to discover which medication or combination of
medications, at which dosages, work best to reduce the frequency and severity of
your headache pain.
While these medications are being used, carefully recording of
your headache frequency and severity on a daily basis will help your doctor
judge how the medications are working. Most of these medications require days to
weeks of daily use before they become fully effective in preventing headaches. A
trial of about 6 weeks is recommended before the effectiveness of a medication
can be judged by your doctor.
Once good headache control has been achieved and maintained for
6 months or a year, it may be possible to taper and stop these medications. In
other cases, it may be necessary to take the medications for a longer period of time.
Preventive therapies have not been approved for use in children.
(see end of document for discussion of ‘off-label’ use).
Important Note About ‘Off-Label’ Prescribing
Many of the medications listed in this handout have not been
approved by the Food and Drug Administration (FDA) for use in children and
adolescents with headaches. When a doctor chooses to prescribe a drug for a
medical condition or for a certain patient type (eg, children) for which it has
not received FDA approval, this practice is called ‘off-label’ prescribing. This
is a common practice in the field of medicine. It is one of the ways by which
new and important uses are found for already approved drugs. Many times,
positive findings lead to formal clinical trials of the drug for new conditions
other than what the drug was first approved for.
Many of the drugs prescribed to help prevent head pain disorders
are prescribed in this off-label fashion. Please check with your doctor
regarding other medications not mentioned in this handout or if you have any
concerns or questions.
Other Notes
Pain medications that are least likely to be habit-forming
should be tried first. In general, narcotic analgesics are not used in children
and adolescents. In all but the most severe headaches, the lowest strength dose
should be tried first. Caution should always be used when taking "stronger"
medications, because the more frequently the medication is taken, the greater
the possibility that they could become harmful and less effective.
Guidelines for Use of Over-the-Counter (OTC) Pain Relievers
Nonprescription pain relievers have been demonstrated to be safe
when used as directed. In addition, keep the following precautions in mind:
- Know the active ingredients in each product. Be sure to read the entire label.
- Do not exceed the recommended dosage for age on the package -- including
for a single dose, for total daily dosage, and total weekly dosage.
- Carefully consider how you use pain relievers and all medications; it is
easy to over-medicate.
- Check with your doctor before taking products containing aspirin,
ibuprofen or naproxen sodium if:
- You or your child has a bleeding disorder
- You or your child has asthma
- You or your child has recently had surgery or dental surgery or are about to have surgery
- You or your child has ulcers, kidney or liver disorders
- You or your child take other nonsteroidal anti-inflammatory medications
- Check with your doctor before taking acetaminophen-containing products
if you or your child has kidney or liver problems.
- Children should not use over-the-counter medications that contain
aspirin and/or caffeine.
- Children and teenagers should not be given aspirin, as aspirin has been
associated with a rare but serious liver and brain disorder called Reye's syndrome.
- Avoid combination medications containing caffeine, barbiturates, and narcotics.
Adapted from the American Council for Headache Education
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