There is a non-medication approach to treating an occasional acute migraine/marked tension headache which is to use cold (wrapping ice or a cold can of soda in a cloth and placing it against the pain site for 10 minutes and waiting 20 minutes and then repeating), shielding your eyes from direct light, laying down in a dark quiet room and drinking plenty of liquids to avoid dehydration.

Medications to treat a headache include the over the counter medications. These are usually most helpful when taken soon after the migraine would begin. For example would include Tylenol, Aleve (naproxen), Advil, Motrin (ibuprofen) or Excedrin. These can be used as the sole treatment for migraine headaches but if one finds that the headaches are leading to the use of these type of medications more than two to three days a month they should discuss other treatment options with their physician. Prescription medications that can be used include those that can be added to over the counter medications such as Reglan or Compazine. These can be oral or suppositories. Other migraine prescription medications include Maxalt, Midrin, and Cafergot, dihydroergotamine (DHE). Again as stated for the over the counter medications if one is using these more than two or three days per month on average they need to discuss further with their physician about other treatment alternatives. Note that narcotics and barbiturates are not recommended for migraine management. Occasionally a migraine headache can be so severe and not respond to home treatments, that patients will come into the clinic or ER for therapy. At this point there are a number of medications that will be tried in this setting and again it is best to avoid narcotics in this setting as well. There are a number of medications including intravenous medicines other than narcotics that are very effective for a severe migraine headache.

The next category of medications that are used for headache disorders in particular for migraine are preventive medications. These are taken daily to prevent or decrease the frequency of migraines. They do not relieve the pain of a migraine once it has started. Use of these medications on a daily basis is usually advised in a setting of averaging more than two to three bad headache days per month. The dosage of these prescription medications is often increased slowly until the effective dose is reached and benefit may take additional weeks to begin. Some of the medications that are used on daily basis include nortriptyline, amitriptyline, propanolol, valproic acid, or verapamil. Additionally some people report benefit from taking vitamin B2 400 mg per day or magnesium up to 250 mg twice a day.

For patients who have more of the muscle contraction Tension-Type headaches, there is usually more of an emphasis in the physical treatment and trying to prevent the headaches but when medications are used it is most likely to be a medication such as nortriptyline or amitriptyline.

For patients with cluster headaches, verapamil may also be used and sometimes lithium is useful. Patients sometimes will benefit from a short course of prednisone to help break a bout of cluster headache. Depakote can sometimes also be useful. Additionally in cluster headaches the acute treatment is also different in that therapies include oxygen inhalation at the start of a headache. Additionally, some of the other migraine medications such as DHE or the triptan medicines may be helpful.