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

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Common Primary Headache Types

Acute/Abortive Headache Treatments: These treatments are designed to provide rapid relief once an attack has started. Their goal is to stop an attack or significantly reduce the severity of symptoms, allowing you to resume your normal activities as quickly as possible. Think of them as your go-to options when an attack strikes.

Preventative Headache Treatments: These treatments are used regularly, even when you don't have a headache attack, to reduce the frequency, severity, and duration of future attacks. The aim is to make attacks less likely to occur in the first place and improve your overall quality of life. Consistency is key with these strategies.

Headache Type	Acute/Abortive Treatments:	Preventive Treatments:
Tension-type headache	• Acetaminophen • Ibuprofen	• Mindfulness therapy • Exercise • Physical therapy • Antidepressants • Anticonvulsants
Migraine	• OTC: Aspirin, Acetaminophen, Ibuprofen, Naproxen • OTC: Combination medications containing aspirin, acetaminophen, and caffeine • Rx: Triptans, ditans, calcitonin gene-related peptides (CGRP) • Neuromodulators	• After thorough evaluation - medication options determined based on how headache is presenting • Healthy lifestyle • Physical therapy • Cognitive Behavioral Therapy
Cluster headache	• Triptans • High Flow 100% oxygen • Non-invasive vagus nerve stimulation	• Verapamil • Topiramate • Corticosteroids • Lithium • Galcanezumab

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Common Secondary Headache Types

Acute/Abortive Headache Treatments: These treatments are designed to provide rapid relief once an attack has started. Their goal is to stop an attack or significantly reduce the severity of symptoms, allowing you to resume your normal activities as quickly as possible. Think of them as your go-to options when an attack strikes.

Preventative Headache Treatments: These treatments are used regularly, even when you don't have a headache attack, to reduce the frequency, severity, and duration of future attacks. The aim is to make attacks less likely to occur in the first place and improve your overall quality of life. Consistency is key with these strategies.

Treatment	Acute/Abortive Treatments:	Preventive Treatments:
Medication overuse headache	• After thorough evaluation, review appropriate usage and either stopping or decreasing use of the drug. Possible bridge therapy with a different drug during withdrawal.	• 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 each individual headache	• 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
Cervicogenic headache	• Education • Exercise • Physical therapy • Medications as warranted	• Education • Exercise • Physical therapy • Medications as warranted