How Are Headaches Treated?

Headaches are one of the most common ailments people experience in their daily lives, but that doesn’t mean they are always easy to treat. While many headaches can be treated with a dose of Bayer (aspirin) or Advil (ibuprofen), others need a more comprehensive treatment plan—especially when headaches occur as part of a chronic headache condition.

The first step to swiftly and successfully treating any headache is knowing what type of headache you’re dealing with since different types of headaches require different treatments. But whatever type of headache you have, the ideal treatment involves a combination of relieving symptoms (especially pain), preventing future headaches, and reducing the overall number of headache episodes you experience.

A neurologist (a medical doctor who specializes in treating conditions of the brain and spinal cord) can help you figure out what type of headache is affecting you and how best to manage your headaches so they interfere with your daily life as little as possible. This might mean taking medication, making specific lifestyle changes, and avoiding your individual headache triggers. 

Treatments by Condition Type

There are three main types of headache disorders: migraine, tension-type headache (TTH), and cluster headache. These are all considered primary headache disorders, meaning there is no underlying cause such as another health condition causing them. They account for about 98% of all primary headaches.

It’s important to know which type of primary headache condition you have; different headache conditions respond differently to common types of treatments, so identifying whether your headaches are migraine, tension, or cluster headaches (or something else) will make it easier for you to treat and prevent them.

There is no cure for migraine or cluster headaches, but there are strategies that can reduce the number of headaches you have each month. Tension-type headaches can sometimes be eliminated by addressing the root cause—for example, if insomnia or depression is triggering headaches. However, they can also become chronic, and may not have an obvious cause that can be treated.

Treatments for Migraine Headache 

Migraine is a headache disorder that affects about 10% of the worldwide population. More than just a “bad headache,” migraine is a neurological condition that causes episodes of intense, stabbing head pain, nausea, and vomiting, and environmental sensitivity to lights, smells, and sounds.

If you have fewer than 15 headache days per month, you have episodic migraine; if you have 15 or more headache days per month, you have chronic migraine. This distinction can determine what drugs and treatments are available to you.

Some people experience something known as an aura—or a visual warning sign—before a migraine happens, but many people with migraine do not. Migraine treatment is usually a two-pronged approach that includes both acute treatments to treat existing migraine symptoms and preventive treatments to reduce the number of migraine episodes.

Acute treatments for migraine include:

• Pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, as well as oral analgesics like Tylenol (acetaminophen), may help treat acute migraine headaches. Also, combination pain relievers—like those containing aspirin, acetaminophen, and caffeine—are efficacious. However, people with certain other health conditions may not be able to take them. Prolonged use can lead to gastrointestinal problems, liver problems, and medication-overuse headaches. 
• Triptans: This is a class of medication that targets the cause of migraine. There are several types of triptans available for getting rid of a migraine, though they are usually only recommended for use up to nine days per month. They are meant to be used as soon as migraine symptoms appear. Triptans can cause side effects like dizziness, fogginess, and fatigue, so some people don’t find them helpful.
• Anti-nausea medications: Your healthcare provider may prescribe these if you feel nauseated or experience vomiting with your migraine.
• CGRP antagonists: A newer class of migraine drugs work by blocking a specific protein, called calcitonin gene-related peptide (CGRP), from being triggered. CGRP is associated with the brain’s pain response signals. Nurtec (rimegepant) is an example of a CGRP antagonist, and it can be taken during a migraine to stop pain and inflammation.

Treatments for preventing migraine include:

• Antidepressants: Tricyclic antidepressants can have an effect on the number and severity of migraine episodes. Studies have shown Elavil (amitriptyline), in particular, to be one of the most effective antidepressants that reduce migraine.
• Beta-blockers: Blood pressure medications, especially Inderal LA (propranolol), can be effective in reducing the number of migraine episodes per month.
• Anticonvulsants: When other treatments fail to prevent migraine, some people find that anti-epilepsy drugs like Topamax (topiramate) help relieve their symptoms. However, many people don’t tolerate Topamax well, as it can cause nausea and loss of appetite, weight loss, and even cognitive confusion.
• CGRP antagonists: Many of the preventive CGRP antagonists are available as a monthly injection, like Emgality (galcanezumab) and Aimovig (erenumab). These drugs are fairly new, but generally have a low incidence of side effects. Nurtec can also be used preventively and acutely.
• Botox injections: If you have chronic migraine and prescription drugs have not helped to reduce your number of migraine days, you may be a candidate for Botox injections. There is some evidence that this somewhat unconventional treatment can reduce the number of migraine days per month, but not everyone is comfortable with the idea of facial injections (and insurance doesn’t always cover the procedure, even when being used medically).
• Lifestyle changes: Many migraine episodes are triggered by something in your environment, whether it’s a weather change, the food or drink you consume, a particular noise or smell, or a disruption to your sleep schedule. Identifying triggers and doing what you can to avoid them can decrease your number of migraine episodes overall.

Treatments for Tension-Type Headache

The treatment for tension-type headaches (TTH) usually depends on how frequent your headaches are. Episodic TTH is common; if you've ever had a stressful afternoon or lost a night of sleep and then experienced pain that felt like a band wrapped tightly around your head, you’ve probably had one. Most of these headaches can be treated with over-the-counter (OTC) pain relievers like Bayer, Advil, or Tylenol.

Some people, however, have TTH more often. If you have 15 or more days per month with TTH, and that frequency persists for three or more months, you may have chronic TTH. This condition requires a more comprehensive treatment plan than taking an OTC pain reliever.

• Pain relievers: The same types of pain relievers used to treat migraine can be effective in relieving symptoms of TTH. Again, not everyone is a candidate for some of these drugs and overuse can lead to other health problems; in general, experts recommend that these drugs not be taken more than two to three times per week to avoid complications.
• Antidepressants: If you have chronic TTH, there is some evidence that certain antidepressants, like Elavil and Effexor (venlafaxine), may reduce TTH frequency. 

Treatments for Cluster Headache

Cluster headaches belong to a group of headache disorders called trigeminal autonomic cephalalgias (TACs). Other types of headaches in this category include paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua, but cluster headaches are the most common within this grouping.

Cluster headaches are marked by excruciating pain that typically comes on suddenly and lasts for a shorter amount of time than migraine and TTH. They are usually debilitating and their cause is still relatively unknown. Similar to migraine, there are both acute and preventive treatments.

Acute treatments for cluster headaches include:

• Oxygen: A safe and effective—though somewhat inaccessible—treatment for cluster headaches, oxygen supplementation can stop a cluster headache in its tracks. Experts aren’t entirely sure why, however, and most people would need to go to their healthcare provider’s office or an urgent care facility to benefit from this treatment.
• Triptans: Triptans are often taken orally, but they can be injected or sprayed intranasally to provide fairly quick relief from cluster headaches.
• Intranasal and injection: Lidocaine nasal spray can help relieve symptoms when used early on in a cluster headache episode. Similarly, a drug called Migranal (dihydroergotamine) can be injected or used intranasally, but in general, injection works better than intranasal and carries less risk of side effects.

Treatments for preventing cluster headaches include:

• Calcium channel blockers: Many primary headache disorders include calcium channel or beta blockers as preventive treatments. While cluster headache is no different, it often benefits from one specific drug more than others: Verelan (verapamil). This drug can lower heart rate and blood pressure, though, so not everyone is a candidate for it.
• Steroids: Corticosteroids seem to be an effective way to stop ongoing cluster headache attacks when used as a short-term treatment (i.e. for a few weeks). However, taking corticosteroids on a long-term basis can lead to other health problems, including an increased risk of infection.
• Lithium: Some people may benefit from using lithium to prevent cluster headaches, but since long-term use of the drug can cause problems with the liver, kidneys, and thyroid, it may not be an option for you.
• Anticonvulsants: Drugs like Topamax may work to prevent cluster headaches, but it’s not a first-line treatment. Usually, anticonvulsants are prescribed when other treatments, like verapamil and lithium, don’t have any effect.

Treatments for Other Primary Headache Disorders

Some recurring headaches not caused by other health conditions don’t fall under the migraine, TTH, or cluster headache categories. They include disorders such as primary cough headache, primary exercise headache, primary thunderclap headache, cold-stimulus headache, hypnic headache, and new daily persistent headache, among others. Treatment for these headaches varies by type, but there are some common strategies if you have one of these primary headache disorders.

• NSAIDs: Certain types of NSAIDs, especially a drug called Indocin (indomethacin), may be effective in treating these headaches as well as possibly preventing them when used before they occur (like in the case of primary exercise headaches). Indomethacin is also noted as a first-line treatment for primary cough headaches and thunderclap headaches.
• Calcium channel or beta blockers: Drugs like Nimotop (nimodipine) and Inderal LA may be effective preventive treatments for some of these headaches, especially thunderclap headaches and primary exercise headaches, because they may be able to reduce the inflammatory response that can cause some types of primary headache disorders.
• Some migraine drugs: Common migraine and TTH treatments, such as Elavil, Topamax, and combination analgesic/caffeine drugs, may be used to prevent or reduce the occurrence of hypnic headaches and new daily persistent headaches.

Living With and Managing Headaches

While many types of primary headache disorders can cause symptoms severe enough to interfere with your daily life, the good news is that these headaches are typically not life-threatening. And though there are no cures for any of the primary headache disorders, there are several different treatment options—both acute and preventive—for each category that can make it easier to live with your headaches.

In some cases, like with migraine and TTH, you may be able to identify the root cause of your headaches and greatly reduce the number of headache days you experience. Even if you can’t, there are other ways to cope with and learn to manage your condition, such as:

• Joining a local or online support group for people with your type of headache condition
• Letting family, friends, and co-workers know of your condition, so they can assist you when you’re experiencing an episode
• Learning your triggers so you can avoid as many headaches as possible
• Keeping a headache diary, which will help both you and your healthcare provider track your symptoms, find patterns in your episodes, and improve your treatment plan
• Finding a therapist or other alternative treatment providers (like acupuncturists) who can provide you with coping mechanisms, tips for talking to people about your condition, and offer stress-reducing strategies which may benefit your overall mental and physical health

Lastly, it’s important to work with a neurologist or headache-knowledgeable primary care physician to formulate a treatment plan for managing your headaches. New treatments are frequently being made available to patients with chronic headaches, and a headache specialist will be able to inform you of these advances and help you decide which ones might be helpful.

A Quick Review

There are three main types of primary headache disorders—migraine, tension-type headache, and cluster headache—as well as several other types of primary headaches that don’t fall into any of those three categories. There are several types of treatments available that work to both treat existing headaches and prevent or reduce the number of future headaches, but it’s important to know which type of primary headache disorder you have so you can find the best treatment.

A neurologist or headache specialist can help you determine your diagnosis, identify any potential triggers or root causes, and work with you to make a treatment plan that helps you stop a headache once it starts and have fewer headaches in the future.