Medications are used in the following ways:

• Analgesic, or pain relief.  Such agents include over-the-counter (OTC) remedies, such as aspirin, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naprosyn, which are used to relieve headache symptoms. Some analgesics require prescriptions and include other NSAIDS, COX-2 inhibitors, neuroleptics, and opioids, or narcotic drugs.
  
  COXIBS: refecoxib, celecoxib. These two COX-2 inhibitors are the first new class of analgesic medication in the last ten years. They offer proven pain relief, while at the same time a significant reduction in risk for gastrointestinal adverse events, such as ulcers and bleeds. They demonstrate very low incidence of cardiovascular adverse events. Rofecoxib is FDA approved for use in acute pain, osteoarthritis, and primary dysmenorrhea. Celecoxib is FDA approved for osteoarthritis and rheumatoid arthritis.

• Abortive. These agents are used to reverse, abort or reduce headaches once they start. They include such medications as ergotamine and the newest class of abortives, the triptans, including sumatripan, rizatriptan, and naratriptan. These medications are most appropriate when used no more than two days a week to avoid the risk of rebound headaches or when prophylactic, or preventive, medicines either aren't effective or can't be used.
• Prophylactic, or preventive. These agents are prescribed when headaches occur more than twice a week and/or are extremely painful. They are also prescribed when other medications or remedies used to treat headache symptoms either don't work or cannot be used. Such agents include beta-blockers, calcium channel blockers and serotonin antagonists.

Medications by Headache Type

Primary Headaches

Migraine Headache Medications

The goal in treating acute migraines is to ease the pain within two hours of treatment with no or only minor side effects. A number of medications have been developed to achieve this goal, most notably the triptans, including sumatriptan, rizatriptan, zolmitriptan and naratriptan.  Hailed as "miracle drugs" following their approval by the U.S. Food and Drug Administration in 1992, these medications work by stimulating various nerve receptors to ultimately turn off the blood vessel inflammation mechanism. 

Listed in this section are medications commonly used to treat migraines and migraine symptoms. (Your treatment may vary depending upon your sensitivity to certain medications or therapy approaches and your health-care provider's recommendations.)

Mild Analgesics (pain relievers) - Aspirin, acetaminophen, and the nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naprosyn.
Comments: For mild headache pain, only. Daily use of aspirin and/or acetaminophen may cause rebound headaches. Frequent use of aspirin and NSAIDs can lead to gastrointestinal bleeding and, in the case of aspirin,  tinnitus (ear ringing).
COXIBS: refecoxib, celecoxib. These two COX-2 inhibitors are the first new class of analgesic medication in the last ten years. They offer proven pain relief, while at the same time a significant reduction in risk for gastrointestinal adverse events, such as ulcers and bleeds. They demonstrate very low incidence of cardiovascular adverse events. Rofecoxib is FDA approved for use in acute pain, osteoarthritis, and primary dysmenorrhea. Celecoxib is FDA approved for osteoarthritis and rheumatoid arthritis.

Ergot Derivatives - Ergotamine tartrate and Dihydroergotamine (DHE).
Comments:

• Ergotamine tartrates (ErgostatSL, Cafergot, Wigraine) were the first effective migraine medications to be developed. They work by stimulating the smooth muscles and stimulating various nerve receptors to turn off blood vessel inflammation. Cafergot contains caffeine, which enhances ergotamine absorption.  Side effects include rebound or chronic headaches. As a result, ergotamine use typically is limited to no more than two days per week.
• DHE is similar to the ergotamines, but is not associated with rebound headaches.  Available as a spray, it is considered front-line treatment for moderate to severe migraine headaches when more modest treatment, such as Midrin, NSAIDs and other analgesics are not effective.

The Triptans - Sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt) and zolmitriptan (Zomig).
Comments:  For best results, use these medications soon after the headache begins. Triptans should not be used with ergotamine migraine medication or if you have coronary artery disease, or heart disease, They may cause flushing, tingling, warmth, numbness or tightness in the chest. Do not use in aura phase of migraine with aura.

• Sumatriptan comes in pill, injection and spray form.
• Zolmitriptan is useful in treating menstrual migraines.

Lidocaine
Comments: Used as a nasal spray, it results in rapid relief of migraine and lasts 10-15 minutes. Headache relapse may occur.

Corticosteroids - Prednisone, dexamethasone (Decadron).
Comments: For severe and prolonged migraines. May cause edema (water retention), hyperglycemia (elevated blood sugar), weight gain  and mood changes.  Steroids are less toxic when used short term.  Prolonged use can lead to complications such as bone loss and Cushing's syndrome.

Mixed Analgesics, with and without Codeine - Includes acetaminophen/codeine and isometheptene (Midrin), a combination drug of isometheptene, acetaminophen, and dichloralphenazone.
Comments: Midrin should not be used if you have coronary artery disease, or with monoamine oxidase inhibitors.

 Magnesium Sulfate
Comments: Various studies have found magnesium to be somewhat effective in treating migraine patients with low blood magnesium levels, including women with premenstrual syndrome and migraines.

Neuroleptics - Drugs generally used for symptomatic relief of headache pain and to treat migraine-induced nausea and vomiting. These include metoclopramide (Reglan); the phenothiazines: chlorpromazine (Thorazine), prochlorperazine (Compazine), perphenazine (Trilafon), promethezine (Phenergan), and Trimethobenzamide (Tigan); and the butyrophenones: haloperidol (Haldol) and droperidol (Inapsine). Some of the newer compounds, including olanzapine (Zyprexa) have been found to be helpful.
Comments: Possible side effects include sleepiness, confusion and low blood pressure.

Preventive Migraine Treatments

Beta-Blockers - Propranolol (Inderal), Atenolol (Tenormin).
Comments: Beta-blockers should not be used if you have Raynaud's disease, congestive heart failure or asthma, nor should treatment abruptly stop. Propranolol is the a first-line treatment for migraine prevention.

Calcium-Channel Blockers - Verapamil (Calan, Isoptin).
Comments: It's widely used, although not FDA approved for migraine or cluster headaches.

Tricyclic Antidepressants - Includes Amitriptyline (Elavil), Nortriptyline (Pamelor), Doxepin (Sinequan).
Comments: May cause dry mouth, blurry vision, urinary retention, constipation or lightheadedness caused by lowering of blood pressure when suddenly arising, particularly in the elderly.Use with caution if you have heart disease, particularly any abnormal rhythms or conduction disturbances.

Anticonvulsants - Valproic Acid (Depakote).
Comments: Recently approved by the FDA for migraine prevention, it may cause weight gain, nausea, vomiting, diarrhea, or dizziness. Note that cases of acute and fatal liver problems have occurred. Warning: Cases of acute and fatal liver problems have been associated with Depakote use.

Serotonin Antagonists - Methysergide (Sansert).
Comments: Not to be used longer than four to six months. It may cause weight gain, hallucination, nausea, muscle aching, insomnia, dizziness, or in rare cases, tissue fibrosis.

Tension-Type Headache Medications

Tension-type headaches may actually be a form of migraine headache, which means that many of the medications that work for migraines may work for these headaches as well. See migraine headache treatment. (Your treatment may vary depending upon your sensitivity to certain medications or therapy approaches or your health-care provider's recommendations.) Following are medications commonly used for treatment of tension-type headaches:

Mild Non-narcotic Analgesics - Aspirin, acetaminophen, and the nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naprosyn.
Comments:  For mild headache, only. Daily use of aspirin and/or acetaminophen may lead to rebound headaches. Frequent use of aspirin and NSAIDs can lead to gastrointestinal bleeding and, in the case of aspirin, tinnitus (ear ringing).
COXIBS: refecoxib, celecoxib. These two COX-2 inhibitors are the first new class of analgesic medication in the last ten years. They offer proven pain relief, while at the same time a significant reduction in risk for gastrointestinal adverse events, such as ulcers and bleeds. They demonstrate very low incidence of cardiovascular adverse events. Rofecoxib is FDA approved for use in acute pain, osteoarthritis, and primary dysmenorrhea. Celecoxib is FDA approved for osteoarthritis and rheumatoid arthritis.

 Mixed Analgesics, with and without Codeine - Includes acetaminophen/codeine and isometheptene (Midrin), a combination drug of isometheptene, acetaminophen, dichloralphenazone.
Comments: For mild to moderate tension-type headaches. Isometheptene should not be used if you have coronary artery disease, or with monoamine oxidase inhibitors. Daily use may lead to rebound headaches.

Tricyclic Antidepressants - Includes amitriptyline (Elavil), nortriptyline (Pamelor), Doxepin (Sinequan).
Comments: May cause dry mouth, blurry vision, urinary retention, constipation  or lightheadedness caused by lowering of blood pressure when suddenly arising, particularly in the elderly. Use with caution if you have heart disease.

Preventative Treatments

Calcium-Channel Blockers - Verapamil (Calan, Isoptin).
Comments: First choice treatment to prevent cluster headaches, although weeks of therapy may be required to control headaches. Agents may cause water retention, fatigue or constipation.

Corticosteroids - Prednisone, dexamethasone (Decadron).
Comments: While 80 percent to 90 percent reliable in preventing cluster headache attacks during active therapy, steroids are not appropriate for prolonged preventive therapy. Used regularly, they may cause side effects, including edema (water retention), hyperglycemia (elevated blood sugar), decreased wound healing, bone resorption and mood changes.

Daily Ergot Derivative Use - Ergotamine tartrate and Dihydroergotamine (DHE).
Comments: 

• Daily use of ergotamine tartrates (ErgostatSL, Cafergot, Wigraine) is reserved for the most extreme and debilitating cases due to a high incidence of side effects, including rebound or chronic headaches. As a result, ergotamine use typically is limited to no more than two days per week.
• DHE is similar to ergotamine, but is not associated with rebound headaches.

The Triptans - Sumatriptan (Imitrex), Naratriptan (Amerge), Rizatriptan (Maxalt) and Zolmitriptan (Zomig).
Comments: For best results, use these medications soon after the headache begins. Triptans should not be used if you have coronary artery disease, heart disease, or with ergotamine migraine medication. They may cause flushing, tingling, warmth, numbness or tightness in the chest. Do not use in aura phase of migraine with aura.  Sumatriptan comes in pill and spray form.

Anticonvulsants - Valproic Acid (Depakote).
Comments: Recently approved by the FDA for migraine prevention, it may cause weight gain, nausea, vomiting, diarrhea and dizziness.  Warning: Cases of acute and fatal liver problems have been associated with Depakote use.

Other Preventive Treatments - A number of other therapies have been used to prevent cluster headaches.  Among them are: lithium, methysergide/methylergonovine, divalproex sodium, and transdermal or oral clonidine.

Symptomatic Cluster Headache Medications/Therapies

Following are some medications and therapies commonly used to treat cluster headaches:

Dihydroergotamine (DHE)
Comments: Similar to ergotamine, DHE is not associated with rebound headaches. It is used as a preventive treatment as well.

The Triptans - Sumatriptan (Imitrex), Naratriptan (Amerge), Rizatriptan (Maxalt) and Zolmitriptan (Zomig).
Comments: For best results, use these medications soon after the headache begins. Use early in the course of the headache for best results. Triptans should not be used if you have coronary artery disease, heart disease or with ergotamine medications. They may cause flushing, tingling, warmth, numbness or tightness in the chest. Sumatriptan comes in pill and spray form.

Neuroleptics - Used for symptomatic relief of headache pain and to treat headache-induced nausea and vomiting. These include metoclopramide (Reglan);
phenothiazines: chlorpromazine (Thorazine), prochlorperazine (Compazine), perphenazine (Trilafon), promethezine (Phenergan), and Trimethobenzamide (Tigan); and
butyrophenones: haloperidol (Haldol) and droperidol (Inapsine).
Comments: Possible side effects include sleepiness, confusion and low blood pressure.  Prolonged regular use can lead to neurological disorders such as Pparkinsonism and tardive dyskinesia.

Opioids - Rectal or nasal sprays.
Comments:  Avoid frequent use.

Other Symptomatic Cluster Headache Treatments - A number of other drugs have been used to treat the symptoms of cluster headaches. Among them are capsaicin and indomethacin (Midrin).

"Ordinary" Headache Medications

Following are some medications commonly used to treat so-called "ordinary" headaches:

Mild Non-narcotic Analgesics - aspirin, acetaminophen, and the nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naprosyn.
Comments:  For mild headache, only. Daily  use of aspirin and acetaminophen may lead to rebound headaches.  Frequent use of aspirin and NSAIDs can lead to gastrointestinal bleeding and, in the case of aspirin, and/ or acctominophen may leat to reboun headaches and tinnitus (ear ringing).
COXIBS: refecoxib, celecoxib. These two COX-2 inhibitors are the first new class of analgesic medication in the last ten years. They offer proven pain relief, while at the same time a significant reduction in risk for gastrointestinal adverse events, such as ulcers and bleeds. They demonstrate very low incidence of cardiovascular adverse events. Rofecoxib is FDA approved for use in acute pain, osteoarthritis, and primary dysmenorrhea. Celecoxib is FDA approved for osteoarthritis and rheumatoid arthritis.

Secondary Headaches Medications

Post-Traumatic Headache Treatment

Treatment of post-traumatic headaches requires a comprehensive, multidisciplinary approach.  In most cases, patients are treated according to specific headache patterns. See migraine headache treatment and tension headache treatment for specific treatments. 

Reactive Headache Treatment

Reactive headaches can be caused by virtually hundreds of external factors. Perhaps the best solution for reactive headache sufferers is to identify and, if possible, avoid or eliminate whatever triggers the headache. A visit to your physician to rule out the more serious causes of reactive headaches is the first step in treating such headaches.  For example, headaches caused by seasonal allergies typically respond to antihistamine medications, topical nasal cortisone and related sprays or desensitization injections used to treat various types of allergies.

Rebound Headache Treatment

Rebound headaches are caused by medication withdrawal following frequent or excessive use of headache pain medications. Treatment typically focuses on detoxification — slowly tapering medications — and on easing side effects, such as nausea.  While the headaches may intensify for a few days following medication withdrawal, rebound headaches usually disappear after three to five days.  Preventive medications are not effective in treating rebound headache until medication withdrawal is complete, which in more severe cases may require hospitalization.  While this detoxification process may eliminate the rebound headache, the original headache (such as migraine, tension-type or cluster) that prompted the overuse of pain medications may still be present following withdrawal. Following are some medications commonly used to treat rebound headaches:
Nonsteroidal Anti-Inflammatory Drugs (NASIDs) - Includes Ibuprofen and Naprosyn.
Comments:  Unlike many other pain-relieving medications, NSAIDs do not cause rebound headaches. Taking small doses may help ease pain during medication withdrawal.
COXIBS: refecoxib, celecoxib. These two COX-2 inhibitors are the first new class of analgesic medication in the last ten years. They offer proven pain relief, while at the same time a significant reduction in risk for gastrointestinal adverse events, such as ulcers and bleeds. They demonstrate very low incidence of cardiovascular adverse events. Rofecoxib is FDA approved for use in acute pain, osteoarthritis, and primary dysmenorrhea. Celecoxib is FDA approved for osteoarthritis and rheumatoid arthritis.

Neuroleptics - Chlorpromazine (Thorazine) or Prochlorperazine (Compazine).
Comments:  Such drugs are used to treat medication withdrawal symptoms such as nausea and vomiting, which are a major side effect of ergotamine withdrawal.

Sinus Headache Medications

Acute or chronic sinusitis, or sinus infections, can cause headaches or trigger pre-existing headache conditions, such as migraines.  Because sinus headaches are among the most misdiagnosed headache conditions, a thorough medical examination is needed to make sure you are, indeed, suffering from a sinus infection-related headache. Headaches caused by acute sinusitis typically are relieved when the sinus infections are cleared up using oral antibiotics. Chronic, or recurring sinus infections may require intravenous antibiotics or surgically draining the sinus cavity, which in turn should relieve your headache.