Headaches can occur on one part of the head or involve the entire head. Pain associated with headache varies from person to person, and may be sudden and sharp or dull and constant. Other symptoms such as nausea can also occur. The main types of headaches include tension, migraine, menstrual migraine, and cluster. An estimated seven out of 10 people experience at least one headache each year; the majority of headaches endure for only a few hours, but some can persist for weeks. Several causes of headaches include but are not limited to scalp and neck muscle tension, allergies, and hormonal imbalance.
Cluster headaches occur in groups or clusters and last for an extended time. Cluster headache pain is extremely severe, but the attack is short-lasting. Pain is centered around one eye, which may become inflamed and watery. Nasal congestion may accompany the cluster headache on the affected side of the face. Cluster headaches can occur in the middle of the night, and often happen at about the same time each day during the course of a cluster. Treatment includes inhalation of oxygen, triptans, ergotamines, and steroids,among others.
Commonly Prescribed (On-Label) Drugs: Dihydroergotamine, Ergotamine, Sumatriptan
Off-Label Prescription Drugs Breakthrough Options: Baclofen, Cortisone, Gabapentin, Indomethacin, Topiramate
In most people, cluster headache prevention requires daily drugs since the headaches are severe and difficult to stop. Criteria for the use of preventive drugs for cluster headaches include the following: the cluster headaches are not easily stopped with drugs; the cluster headaches occur daily and last longer than 15 minutes; and the person is willing to take drugs and endure potential drug side effects. Preventive drugs for cluster headache include SSRIs, calcium channel blockers, anticonvulsants, steroids, ergotamines, and lithium, among others.
Commonly Prescribed (On-Label) Drugs: Methylergonovine
Off-Label Prescription Drugs Breakthrough Options: Baclofen, Gabapentin, Lithium, Topiramate, Verapamil
Lumbar puncture-induced headache is a recognized complication of lumbar punctures most commonly from an epidural, and is related to the loss of cerebrospinal fluid. If you are sitting or are in an upright position, the pain is relieved once you lie down. Nausea, photophobia (unusual sensitivity to light), or other vision changes may accompany lumbar puncture-induced headache. Symptoms are managed with bed rest, remaining in a reclined position, and drug treatments.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drug Breakthrough Option: Sumatriptan
Menstrual migraine is a type of headache that occurs in women two days before and up until the last day of menstruation. Factors that play a role in the development of menstrual migraine include hormone levels, blood platelet dysfunction, decreased levels of brain magnesium, decreased natural brain endorphins, and increased secretion of prostaglandins (a substance that causes inflammation in brain blood vessels). A variety of treatments are used to manage menstrual migraine, including hormone drugs and pain drugs.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Danazol, Leuprolide, Mefenamic acid
Migraines are recurrent, throbbing, or pulsating headaches that often run in families, and strike three times as many women as men. They often occur on one side of the head and can be accompanied by nausea, vomiting, sensitivity to light, sound, and smells, sleep disruption, and depression. They may be triggered by menstrual or altered sleep cycles, missed meals, sunlight, certain foods, excessive noise, stress, or underlying depression. Attacks tend to become less severe with age.
Commonly Prescribed (On-Label) Drugs: Almotriptan, Aspirin, Dihydroergotamine, Eletriptan, Ergotamine, Frovatriptan, Isometheptene, Methysergide, Naratriptan, Propranolol, Rizatriptan, Sumatriptan, Timolol, Topiramate, Valproic Acid, Zolmitriptan
Off-Label Prescription Drugs Breakthrough Options: Botulinum Toxin Type A, Lidocaine, Magnesium Sulfate, Metoclopramide
The goal of migraine prevention is to reduce the occurrence of migraine headache. Physicians will prescribe preventive treatment if migraines are frequent, disabling, or associated with neurologic features, or if acute treatment is ineffective or overused. It is recommended that the selected drug be tested in the absence of interfering or ineffective drugs, so your doctor needs to consider other diseases or conditions that you have. It is important to note that only a few drugs available for migraine prevention have proven effective. Also, some preventive drugs take weeks or months before they are completely effective.
Commonly Prescribed (On-Label) Drugs: Topiramate, Valproic Acid
Off-Label Prescription Drugs Breakthrough Options: Amitriptyline, Atenolol, Baclofen, Botulinum Toxin Type A, Candesartan, Diltiazem, Doxepin, Fluoxetine, Fluvoxamine, Gabapentin, Imipramine, Lisinopril, Metoprolol, Mirtazapine, Nadolol, Nortriptyline, Phenelzine, Tiagabine, Tizanidine, Trazodone, Venlafaxine, Verapamil
The International Headache Society (IHS) classifies episodic tension headache as 10 previous headache episodes lasting from 30 minutes to seven days and happening less than 180 times per year. Pain symptoms of tension headache include at least two of the following: pressing/tightening located on both sides of the head; mild to moderate intensity; not triggered by physical activity; not accompanied by nausea or vomiting; and possible sensitivity to light, sound, or both. Treatment of tension headache includes over-the-counter (aspirin, acetaminophen) or prescription drugs.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Botulinum Toxin Type A, Lorazepam, Tizanidine
Approximately 69% of men and 88% of women develop tension headache during their life. Tension headaches can be episodic or chronic; pain may affect both sides of the head, or it can be localized to the forehead, temples, or back of head. Prevention includes use of drugs in the following classes: antidepressants, beta-blockers, and anticonvulsants. Doctors will usually start tension headache treatment with newer types of antidepressants, and will increase the dose until you get a therapeutic effect.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Baclofen, Botulinum Toxin Type A, Candesartan, Fluoxetine, Levetiracetam, Tizanidine, Venlafaxine
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