Editing Headache (section)

== Management ==
[[File:Image-Lottie Collins sings and dances to the tunes of Ta-Ra-Ra Boom-de-ay in a Bromo-Seltzer ad.jpg|thumb|An old advertisement for a headache medicine]]
{{See also|Management of chronic headaches}}
Primary headache syndromes have many different possible treatments. In those with chronic headaches the long term use of opioids appears to result in greater harm than benefit.<ref>{{cite journal | vauthors = Franklin GM | title = Opioids for chronic noncancer pain: a position paper of the American Academy of Neurology | journal = Neurology | volume = 83 | issue = 14 | pages = 1277–1284 | date = September 2014 | pmid = 25267983 | doi = 10.1212/WNL.0000000000000839 | doi-access = free }}</ref>

=== Secondary headaches (caused by another disease) ===
Treatment of secondary headaches involves treating their underlying cause. For example, a person with meningitis will require antibiotics, and a person with a [[brain tumor]] may require surgery, [[chemotherapy]] or brain radiation. The [[Headache#Secondary|possible origins of a headache]] have been studied and classified.

=== Migraines ===
[[Migraines|Migraine]] can be somewhat improved by lifestyle changes, but most people require medicines to control their symptoms.<ref name=Goadsby /> Medications are either to prevent getting migraines, or to reduce symptoms once a migraine starts.{{citation needed|date=June 2021}}

Preventive medications are generally recommended when people have more than four attacks of migraine per month, headaches last longer than 12 hours or the headaches are very disabling.<ref name=Goadsby /><ref name="UTD Migraine Tx">{{cite report | vauthors = Bajwa ZH, Sabahat A | title = Preventive Treatment of Migraine in Adults. | work = UptoDate | veditors = Swanson JW | location = San Francisco, CA. | publisher = Wolters Kluwer <!-- | access-date = 24 April 2014 --> }}</ref> Possible therapies include beta blockers, antidepressants, anticonvulsants and NSAIDs.<ref name="UTD Migraine Tx" /> The type of preventive medicine is usually chosen based on the other symptoms the person has. For example, if the person also has depression, an antidepressant is a good choice.{{citation needed|date=June 2021}}

Abortive therapies for migraines may be oral, if the migraine is mild to moderate, or may require stronger medicine given intravenously or intramuscularly. Mild to moderate headaches should first be treated with [[acetaminophen]] (paracetamol) or NSAIDs, like [[ibuprofen]]. If accompanied by nausea or vomiting, an antiemetic such as metoclopramide (Reglan) can be given orally or rectally. Moderate to severe attacks should be treated first with an oral [[triptans|triptan]], a medication that mimics [[serotonin]] (an agonist) and causes mild vasoconstriction. If accompanied by nausea and vomiting, parenteral (through a needle in the skin) triptans and antiemetics can be given.<ref>{{cite journal | vauthors = Láinez MJ, García-Casado A, Gascón F | title = Optimal management of severe nausea and vomiting in migraine: improving patient outcomes | journal = Patient Related Outcome Measures | volume = 4 | pages = 61–73 | date = October 2013 | pmid = 24143125 | pmc = 3798203 | doi = 10.2147/PROM.S31392 | doi-access = free }}</ref>

Sphenopalatine ganglion block (SPG block, also known nasal ganglion block or [[pterygopalatine ganglion]] blocks) can abort and prevent migraines, tension headaches and cluster headaches. It was originally described by American ENT surgeon Greenfield Sluder in 1908. Both blocks and neurostimulation have been studied as treatment for headaches.<ref>{{cite journal | vauthors = Boss KW, Przkora R, Kumar S | title = Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review | journal = The Journal of Headache and Pain | volume = 18 | issue = 1 | pages = 118 | date = December 2017 | pmid = 29285576 | pmc = 5745368 | doi = 10.1186/s10194-017-0826-y | doi-access = free }}</ref>

Several complementary and alternative strategies can help with migraines. The American Academy of Neurology guidelines for migraine treatment in 2000 stated [[relaxation training]], electromyographic feedback and [[cognitive behavioral therapy]] may be considered for migraine treatment, along with medications.<ref>{{cite journal | vauthors = Silberstein SD | title = Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 55 | issue = 6 | pages = 754–762 | date = September 2000 | pmid = 10993991 | doi = 10.1212/wnl.55.6.754 | doi-access = free }}</ref>

=== Tension-type headaches ===
[[Tension-type headache]]s can usually be managed with [[NSAIDs]] ([[ibuprofen]], [[naproxen]], [[aspirin]]), or [[acetaminophen]].<ref name=Goadsby /> [[Triptans]] are not helpful in tension-type headaches unless the person also has migraines. For chronic tension type headaches, [[amitriptyline]] is the only medication proven to help.<ref name=Goadsby /><ref name="UpToDate Tension">{{cite web | vauthors = Taylor R | title = Tension type headaches in adults: Preventive treatment. | work = UpToDate | veditors = Swanson JW | publisher = Wolters Kluwer | location = San Francisco, CA | access-date = 24 April 2014 | url = https://www.uptodate.com/contents/tension-type-headache-in-adults-acute-treatment }}</ref><ref name="Amitryptiline">{{cite journal | vauthors = Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, Berbano E, O'Malley PG | title = Tricyclic antidepressants and headaches: systematic review and meta-analysis | journal = BMJ | volume = 341 | pages = c5222 | date = October 2010 | pmid = 20961988 | pmc = 2958257 | doi = 10.1136/bmj.c5222 }}</ref> [[Amitriptyline]] is a medication which treats depression and also independently treats pain. It works by blocking the reuptake of [[serotonin]] and norepinephrine, and also reduces muscle tenderness by a separate mechanism.<ref name="UpToDate Tension" /> Studies evaluating acupuncture for tension-type headaches have been mixed.<ref name="pmid18499526">{{cite journal | vauthors = Davis MA, Kononowech RW, Rolin SA, Spierings EL | title = Acupuncture for tension-type headache: a meta-analysis of randomized, controlled trials | journal = The Journal of Pain | volume = 9 | issue = 8 | pages = 667–677 | date = August 2008 | pmid = 18499526 | doi = 10.1016/j.jpain.2008.03.011 | doi-access = free }}</ref><ref name="pmid27092807">{{cite journal | vauthors = Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin BC, Vickers A, White AR | title = Acupuncture for the prevention of tension-type headache | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 8| pages = CD007587 | date = April 2016 | pmid = 27092807 | pmc = 4955729 | doi = 10.1002/14651858.CD007587.pub2 }}</ref><ref name="pmid23075410">{{cite journal | vauthors = Hao XA, Xue CC, Dong L, Zheng Z | title = Factors associated with conflicting findings on acupuncture for tension-type headache: qualitative and quantitative analyses | journal = Journal of Alternative and Complementary Medicine | volume = 19 | issue = 4 | pages = 285–297 | date = April 2013 | pmid = 23075410 | doi = 10.1089/act.2013.19608 }}</ref><ref name="pmid16430123">{{cite journal | vauthors = Melchart D, Streng A, Hoppe A, Brinkhaus B, Becker-Witt C, Hammes M, Irnich D, Hummelsberger J, Willich SN, Linde K | title = The acupuncture randomised trial (ART) for tension-type headache--details of the treatment | journal = Acupuncture in Medicine | volume = 23 | issue = 4 | pages = 157–165 | date = December 2005 | pmid = 16430123 | doi = 10.1136/aim.23.4.157 | s2cid = 23437975 }}</ref><ref>{{cite journal | vauthors = Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes M, Hummelsberger J, Irnich D, Weidenhammer W, Willich SN, Linde K | title = Acupuncture in patients with tension-type headache: randomised controlled trial | journal = BMJ | volume = 331 | issue = 7513 | pages = 376–382 | date = August 2005 | pmid = 16055451 | pmc = 1184247 | doi = 10.1136/bmj.38512.405440.8f }}</ref> Overall, they show that acupuncture is probably not helpful for tension-type headaches.

=== Cluster headaches ===
[[Therapy|Abortive therapy]] for cluster headaches includes subcutaneous sumatriptan (injected under the skin) and triptan nasal sprays. High flow oxygen therapy also helps with relief.<ref name=Goadsby />

For people with extended periods of cluster headaches, preventive therapy can be necessary. Verapamil is recommended as first line treatment. Lithium can also be useful. For people with shorter bouts, a short course of prednisone (10 days) can be helpful. Ergotamine is useful if given 1–2 hours before an attack.<ref name=Goadsby />

=== Neuromodulation ===
Peripheral neuromodulation has tentative benefits in primary headaches including cluster headaches and chronic migraine.<ref name=Reed2013>{{cite journal | vauthors = Reed KL | title = Peripheral neuromodulation and headaches: history, clinical approach, and considerations on underlying mechanisms | journal = Current Pain and Headache Reports | volume = 17 | issue = 1 | pages = 305 | date = January 2013 | pmid = 23274677 | pmc = 3548086 | doi = 10.1007/s11916-012-0305-8 }}</ref> How it may work is still being looked into.<ref name=Reed2013/>