There are three main aspects of treatment: trigger avoidance, acute symptomatic control, and medication for prevention. Medications are more effective if used earlier in an attack. The frequent use of medications may result in medication overuse headache, in which the headaches become more severe and more frequent. This may occur with triptans, ergotamines, and analgesics, especially opioid analgesics. Due to these concerns simple analgesics are recommended to be used less than three days per week at most. Analgesics Recommended initial treatment for those with mild to moderate symptoms are simple analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) or the combination of paracetamol (also known as acetaminophen), aspirin, and caffeine. Several NSAIDs, including diclofenac and ibuprofen have evidence to support their use. Aspirin (900 to 1000 mg) can relieve moderate to severe<unk>  pain, with an effectiveness similar to sumatriptan. Ketorolac is available in intravenous and intramuscular formulations. Paracetamol, either alone or in combination with metoclopramide, is another effective treatment with a low risk of adverse effects. Intravenous metoclopramide is also effective by itself. In pregnancy, paracetamol and metoclopramide are deemed safe as are NSAIDs until the third trimester. Naproxen by itself may not be effective as a stand-alone medicine to stop a<unk>  headache as it is only weakly better than a placebo medication in clinical trials. Antiemetics Triptans Triptans such as sumatriptan are medications used to stop an active<unk>  headache (an abortive medication). Triptans are the initially recommended treatments for those with moderate to severe pain from an acute<unk>  headache or those with milder symptoms who do not respond to simple analgesics. Triptans have been shown to be effective for both pain and nausea in up to 75% of people. There are different methods or routes of administration to take sumatriptan including oral (by mouth), injectable (subcutaneous), rectal, nasal spray, and oral dissolving tablets. For people with<unk>  symptoms such as nausea or vomitting, taking the abortive medicine by mouth or through the nose may be difficult. All route of administration have been shown to be effective at reducing<unk>  symptoms, however, nasal and injectable subcutaneous administration may result in more side effects. The adverse effects associated with rectal administration have not been well studied. Some people may find that they respond to one type of sumatripton better than another. Most side effects are mild, including flushing; however, rare cases of myocardial ischemia have occurred. They are thus not recommended for people with cardiovascular disease, who have had a stroke, or have<unk> s that are accompanied by neurological problems. In addition, triptans should be prescribed with caution for those with risk factors for vascular disease. While historically not recommended in those with basilar<unk> s there is no specific evidence of harm from their use in this population to support this caution. Triptans are not addictive, but may cause medication-overuse headaches if used more than 10 days per month. Sumatriptan does not prevent other<unk>  headaches from starting in the future. For increased effectiveness at stopping<unk>  symptoms, a combined therapy that includes sumatriptan and naproxen may be suggested. CGRP receptor antagonists CGRP receptor antagonists target calcitonin gene-related peptide or its receptor to prevent<unk>  headaches or reduce their severity. CGRP is a signaling molecule as well as a potent vasodilator that is involved in the development of a<unk>  headache. There are four injectable monoclonal antibodies that target CGRP or it's receptor (eptinezumab, erenumab, fremanezumab and galcanezumab) and the medications have demonstrated efficacy in the preventative treatment of episodic and chronic<unk>  headaches in phase 3 randomized clinical trials. Eptinezumab is available as an infusion every three months, Erenumab and galcanezumab are once monthly injections and fremanezumab is a monthly or quarterly injection. Ergotamines Ergotamine and dihydroergotamine are older medications still prescribed for<unk> s, the latter in nasal spray and injectable forms. They appear equally effective to the triptans and experience adverse effects that typically are benign. In the most severe cases, such as those with status<unk> sus, they appear to be the most effective treatment option. They can cause vasospasm including coronary vasospasm and are contraindicated in people with coronary artery disease. Magnesium Magnesium is recognized as an inexpensive, over-the-counter supplement which some studies have shown to be effective in both preventing and treating<unk>  in intravenous form. Other Intravenous metoclopramide, intravenous prochlorperazine, or intranasal lidocaine are other potential options. Metoclopramide or prochlorperazine are the recommended treatment for those who present to the emergency department. Haloperidol may also be useful in this group. A single dose of intravenous dexamethasone, when added to standard treatment of a<unk>  attack, is associated with a 26% decrease in headache recurrence in the following 72 hours. Spinal manipulation for treating an ongoing<unk>  headache is not supported by evidence. It is recommended that opioids and barbiturates not be used due to questionable efficacy, addictive potential, and the risk of rebound headache. There is tentative evidence that propofol may be useful if other measures are not effective. Occipital nerve stimulation, may be effective but has the downsides of being cost-expensive and has a significant amount of complications. There is modest evidence for the effectiveness of non-invasive neuromodulatory devices, behavioral therapies and acupuncture in the treatment of<unk>  headaches. There is little to no evidence for the effectiveness of physical therapy, chiropractic manipulation and dietary approaches to the treatment of<unk>  headaches. Behavioral treatment of<unk>  headaches may be helpful for those who may not be able to take medications (for example pregnant women). Feverfew is registered as a traditional herbal medicine in the Nordic countries under the brand name Glitinum, only powdered feverfew is approved in the Herbal community monograph issued by European Medicines Agency (EMA). Sexual activity, particularly orgasm, may provide relief for some<unk> urs. Children Ibuprofen helps decrease pain in children with<unk> s and is the initially recommended treatment. Paracetamol does not appear to be effective in providing pain relief. Triptans are effective, though there is a risk of causing minor side effects like taste disturbance, nasal symptoms, dizziness, fatigue, low energy, nausea, or vomiting. Ibuprofen should be used less than half the days in a month and triptans less than a third of the days in a month to decrease the risk of medication overuse headache. Chronic<unk>  Topiramate and botulinum toxin (Botox) have evidence in treating chronic<unk> . Botulinum toxin has been found to be useful in those with chronic<unk>  but not those with episodic ones. The anti-CGRP monoclonal antibody erenumab was found in one study to decrease chronic<unk> s by 2.4 days more than placebo.
Migraine
Cluster headache
Lupus headache
Subarachnoid hemorrhage
Tension headache
Sinusitis
External compression headache
Brain tumor