Chapter 6. Pharmacologic (drug) & Non-pharmacologic (non-drug ) Options.

2023 VA/DoD Clinical Practice Guideline Summary-Primary Care Management of Headache, Provider Summary


Common Primary Headache Acute/Abortive Treatments:

Stop headache attack-Use as soon as you can. Don’t Wait!

Tension type headache
  • Acetaminophen
  • Ibuprofen
Migraine
  • OTC: Aspirin, Acetaminophen, Ibuprofen, Naproxen
  • OTC: Combination medications containing aspirin, acetaminophen, and caffeine
  • Rx: Triptans, ditans, calcitonin gene-related peptides (CGRP)
  • Neuromodulators
Cluster headache
  • Triptans
  • High Flow 100% oxygen
  • Non-invasive vagus nerve stimulation

Common Primary Headache Preventive Treatments

Reduce frequency and/or severity

Tension type headache
  • Mindfulness therapy
  • Exercise
  • Physical therapy
  • Antidepressants
  • Anticonvulsants
Migraine
  • Mindfulness-based therapies
  • Exercise
  • Dietary factors avoidance
  • Vitamins or supplements
  • Blood pressure medications
  • Antiseizure medications
  • Antidepressant medications
  • CGRP inhibitors
  • Botulinum Toxins
  • Occipital nerve injections
  • Neuromodulators
  • Sleep hygiene
Cluster headache
  • Verapamil
  • Topiramate
  • Corticosteroids
  • Lithium
  • Galcanezumab

Common Secondary Headache Acute/Abortive Treatments

Medication Overuse
  • After thorough evaluation, review appropriate usage and either stopping or decreasing use of the drug. Possible bridge therapy with a different drug during withdrawal.
Post Traumatic Headache
  • After thorough evaluation, medication options determined based on each individual headache
Cervicogenic headache
  • Education
  • Exercise
  • Physical therapy
  • Medications as warranted

Common Secondary Headache Preventative Treatments

Medication Overuse
  • Be mindful of medicines that are prone to cause Medication Overuse Headache and limit their use.
Post Traumatic Headache
  • After thorough evaluation - medication options determined based on how headache is presenting
  • Healthy lifestyle
  • Physical therapy
  • Cognitive Behavioral Therapy
Cervicogenic headache
  • Education
  • Exercise
  • Physical therapy
  • Medications as warranted