Tension-type headache and migraine – management
How to manage tension-type headache and migraines
The management of tension-type headache (TTH) and migraines are similar. Each patient needs to be assessed to determine what it is they have, ruling out signs and symptoms that may indicate other more serious causes of the headache, treating the acute pain and counselling patients on how to avoid triggers.1
Treatment of the acute pain however, can differ depending on whether it is a TTH or migraine and, can include both non-pharmacological and pharmacological methods. Additionally, there are specific treatments for acute migraine attacks and preventive therapy.1
Management of tension-type headache and migraines
Non-pharmacological management for headaches 1,2
Some of these methods could help patients suffering from headaches find relief. Depending on the pain intensity, these might work alone or support better relief together with medications.
Consider recommending a headache diary to your patient
This will help them track triggers and also the types of medicines they are on and, how effective they are
|Advice rest in a dark and quiet room|
|Sleeping can help, if possible|
|Apply a cold compress to the head|
|Learning stress management skills|
|Adjusting lifestyle such as reducing caffeine intake, ensuring regular exercise and avoiding irregular or inadequate sleep|
Pharmacological management for headaches 1-3
For treating acute attacks:
|Mild-TTH may not require treatment||Mild-to-moderate migraines can be treated with adequate doses of analgesics like paracetamol or NSAIDs|
|Moderate-to-severe TTH can be treated with appropriate doses of analgesics such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium||
Severe migraines may require more migraine specific drugs like triptans or ergot alkaloids
If the migraine has associated symptoms such as nausea and/or vomiting, add supporting drugs like antiemetics (metoclopramide or domperidone)
Preventive treatment for TTH is usually non-pharmacological
However, if the patient suffers from severe or chronic TTH, drugs such as amitriptyline or mirtazapine may be considered
Preventive treatment for migraines are mostly prescription drugs:
- First choice drugs like beta-blockers (propranolol and metoprolol), flunarizine, valproic acid and topiramate
- Second choice includes amitriptyline, naproxen, petasites extract and bisoprolol
Remember to determine if your patients are able to take these medications prior to recommending them. Consider if they have comorbidities such as chronic kidney disease, liver disease, peptic ulcer disease and cardiovascular disease and, if they are on any medications that may interact with treatment for the headache.
Understanding headaches and migraines
How do they present?
Find out the signs and symptoms of tension-type headache and migraine. Learn to differentiate them and learn about “red flag” symptoms that indicate a referral to a doctor.