Acute Treatment


There are many headache treatments, including conventional medical treatments as well as alternative therapies. It is ironic that treatments that have been successfully in use for hundreds if not thousands of years such as herbal treatments, acupuncture, ayurvedic treatments, and lifestyle changes have been termed alternative, while modern medical treatments, which have been in vogue for not even a century, are considered conventional or traditional, when it should be the other way around.

Secondary Headaches
The conventional treatments are concerned with treating the underlying cause of the headache, such as infection or tumor in the brain.

Primary Headache
Most conventional treatment is aimed at symptomatic relief (pain control), and does not address the cause of the pain. Many drugs address the symptoms of the pain as well as the associated symptoms of anxiety, insomnia, depression, mood changes, and the like. There is no perfect treatment for headache.

But this statement is true only for conventional medicine. The conventional assumption that there is no identifiable cause does not mean that there is no cause. It just means that our current diagnostic acumen is not able to identify the cause. According to medical textbooks, headaches, especially migraines, are chronic conditions that cannot be prevented or cured, but can be managed only by our current approaches. Alternative medicine can provide help in diagnosing the causes and recommending a cure.

  • Effective conventional therapies for acute pain relief of migraine include OTC and prescription medications including nonspecific and migraine-specific medications.

  • Triptans are the most effective migraine-specific medications for acute pain relief.

  • Opioids and other narcotic medications should be used sparingly, as they can cause tolerance and addiction.

  • There are established guidelines for the use of medications for relief of the headache of migraine.

The current general principles of acute migraine care include the following:

  1. Treat the headache as early as possible to reduce the intensity and duration of the pain as well as the accompanying features. Waiting until the headache becomes moderate-to-severe seems to decrease the effectiveness of acute treatments.

  2. Individualize the treatment to both the individual and the type of the pain. Instead of using the step approach (discussed on the next page), use the most effective therapy early. The step approach may increase the pain, disability, and impact of the headache.

  3. Use the correct dose and formulation specific for the particular type of headache. This means using the stratified approach, not only in terms of choosing the right medication, but also the right dosage of the medication. In other words, it is more effective to start with the right dose than to start with a low dose and slowly increase it until you get the desired effect.

  4. The route of administration is especially important in patients experiencing severe nausea and vomiting. In these cases, the tablet form of the medication may not be effective, and the patient may need an alternative mode of administration, such as an injection, nasal spray, or tablets that dissolve in the mouth.

  5. Generally, the use of acute medication should be restricted to a maximum of two to three days per week to avoid rebound or medication-overuse headache.

  6. Everyone needs acute treatment.

Most headache sufferers have tried some form of OTC medication before seeing a physician. In fact, most headache sufferers do not seek professional help on a regular basis. A multitude of medications can be found on the shelves of major pharmacies and drug stores. Be aware that most medications have two names, the brand name and the generic name. For the same generic medication, there may be many brand names. These drugs are non-specific and designed to provide temporary relief of acute pain.

Despite the large number of medications with different brand names available on the market, the ingredients in most of these medications are mainly three: aspirin, acetaminophen, and ibuprofen.

The major differences in OTC medications are the amount of the generic medication and the combination with other medications. For example, Extra Strength Excedrin is a combination of aspirin, acetaminophen, and caffeine. Similarly, Advil is the brand name for ibuprofen. Other brand names for ibuprofen are Nuprin, Motrin, and Medipren.

Most of the migraine-specific drugs belong to a group of medications called triptans. The more technical term for triptans is selective serotonin receptor agonists. The important non-triptan drugs are dihydroergotamine (DHE) and ergotamine (Cafergot, Ergostat).

Important points to consider:

  1. Some of you may not respond to a triptan on the first try. Take it at least two or three times before discarding it.

  2. The medication may not work for all migraine attacks.

  3. The medication may not provide complete relief of the headache but may decrease the severity of the pain to a more manageable level.

  4. For best relief, take the medication at the first symptom of the migraine.

  5. Triptans do not prevent recurrence of the headache.

  6. Triptans do not prevent recurrence of the headache.