Headache Medications There are two types of headache medications: preventative and acute medications. Preventative medications are taken every day whether you have a headache or not, and they may prevent future headaches from developing. These medications take several weeks to take effect. They will not impact today's headache, but may reduce the number of headaches you experience in the next few weeks or months. A successful preventative medication will reduce the number of headaches experienced in a month by 50%, or reduce the intensity of the headaches by 50%. So, if you normally have 15 headaches per month, a really good response to these medications would be a following month with only 7 headaches. Or, instead of most of your headaches being 8 out of 10 in intensity, they are more often 4 out of 10 in intensity. Doubling up on the medication today will not help with today's headache. Most likely, you'll just increase the medication side effect. This is why it is important to continue with a steady dose.   Acute headache medications are those that you take when you get a headache with the hopes that it will relieve your pain. These medications are quite different from the preventative medications. Acute headache medications are the ones that most people associate with headache treatment. They include over-the-counter medications like Tylenol and prescription medications like Imitrex.  These acute headache medications should only be used one to three times per week. If you use them more frequently, it is possible that you could find your headaches becoming more frequent. In only a couple of weeks, the overuse of these medications can lead to the development of rebound headache. This is a condition where headache medications cause your headaches to become more frequent. This vicious cycle then increases your consumption of headache medications, which then causes your headaches to occur more frequently and also to be more resistant to treatment. See my section on Rebound Headache for more detail. Preventative (Taken Daily) These are the medications I prescribe for the prevention of headaches. Most medications were first used for another purpose and then later found to be useful in preventing headaches. The side effect profile, or how the medication interacts with other medications you are already taking is often the most important factor in determining which medication to prescribe. Sometimes we also look at medications that can do two jobs. For instance, if you have high blood pressure, then starting Inderal may help with your headaches and blood pressure.  Blood Pressure Medications Inderal (Propanolol) Blocadren (Timolol) Calan (Verapamil)  Anti-Seizure Medications Topamax (Topiramate) Depakote (Valproic Acid) Neurontin (Gabapentin)  Anti-Depressant Medications Pamelor (Nortriptyline) Elavil (Amitriptyline) Effexor (Venlafaxine) Nardil (Phenelzine)  Muscle Relaxants Lioresal (Baclofen)  Drugs That Affect Platelets Aspirin  Non-Prescription Supplements Riboflavin Magnesium Co-enzyme Q10 Feverfew  Injections Botulinum Toxin (Botox) Acute Headache Medications These are the medications you reach for when a headache starts. They are maximally effective if taken within one hour of the onset of a headache. If a headache has been going on for several hours, it is possible these will not work so well. Often the headache will just run its course regardless of how much medication you take. Again, I suggest being very careful about how often you take these medications. Optimally they should be used no more than one time per week or five times per month.  Over-the-Counter Acetaminophen (Tylenol) Ibuprofen (Motrin) Aspirin  Prescription Anti-Inflammatories Indomethacin Naproxen (Alleve) Celexbrex (Celecoxib) Mobic (Meloxicam)  Triptans Imitrex (Sumatriptan) Zomig (Zomatriptan) Maxalt Relpax  Ergotamines DHE  Anti-Nausea Medications That Also Relieve Headaches Thorazine Compazine Reglan Phenegran (mostly used for nausea only) Preventative Medications That I Sometimes Use There are some medications that may prevent headaches but have either not been proven to be effective or have other contraindications. Seroquel (Quetiapine) Zyprexa (Olanzapine) Zanaflex (Tizanidine) - a muscle relaxant used sometimes also in fibromyalgia Daily Triptans the week prior to menses Ambien ((Zolpidem) for regulation of sleep Lidocaine injections Medications Sometimes Used In Special Situations I occasionally use these for headaches during treatment for rebound headache. I usually limit their use to one to two weeks. Steroids (Prednisone) Ativan Ambien Medications Used In Select Patients (Only One to Three Times Per Month)  These medications are not appropriate for most patients. Because they so often cause the development of treatment-resistant daily headaches, I will not prescribe them to patients with more than three headaches per month. See Do Not Take These Medications For Headaches for more detail.  Medications Containing Barbiturates Fioricet Fiorinal  Medications Containing Caffeine Excedrin Migraine BC Powder Cafergot  All Medications Containing Narcotics (Here are a few examples) Morphine Codeine Demerol Stadol (Butorphanol) Methadone Ultram (Tramadol) Percocet Vicodin ** Note that regular use of these medications that exceeds my suggested dosage requires a second opinion and evaluation by a headache specialist in the States. Return to Headaches Continue to Do Not Use These Medications for Headache

Headache Medications

There are two types of headache medications: preventative and acute medications. Preventative medications are taken every day whether you have a headache or not, and they may prevent future headaches from developing. These medications take several weeks to take effect. They will not impact today's headache, but may reduce the number of headaches you experience in the next few weeks or months. A successful preventative medication will reduce the number of headaches experienced in a month by 50%, or reduce the intensity of the headaches by 50%. So, if you normally have 15 headaches per month, a really good response to these medications would be a following month with only 7 headaches. Or, instead of most of your headaches being 8 out of 10 in intensity, they are more often 4 out of 10 in intensity. Doubling up on the medication today will not help with today's headache. Most likely, you'll just increase the medication side effect. This is why it is important to continue with a steady dose.

Acute headache medications are those that you take when you get a headache with the hopes that it will relieve your pain. These medications are quite different from the preventative medications. Acute headache medications are the ones that most people associate with headache treatment. They include over-the-counter medications like Tylenol and prescription medications like Imitrex.

These acute headache medications should only be used one to three times per week. If you use them more frequently, it is possible that you could find your headaches becoming more frequent. In only a couple of weeks, the overuse of these medications can lead to the development of rebound headache. This is a condition where headache medications cause your headaches to become more frequent. This vicious cycle then increases your consumption of headache medications, which then causes your headaches to occur more frequently and also to be more resistant to treatment. See my section on Rebound Headache for more detail.

Preventative (Taken Daily)
These are the medications I prescribe for the prevention of headaches. Most medications were first used for another purpose and then later found to be useful in preventing headaches. The side effect profile, or how the medication interacts with other medications you are already taking is often the most important factor in determining which medication to prescribe. Sometimes we also look at medications that can do two jobs. For instance, if you have high blood pressure, then starting Inderal may help with your headaches and blood pressure.

Blood Pressure Medications
Inderal (Propanolol)

Blocadren (Timolol)

Calan (Verapamil)

Anti-Seizure Medications
Topamax (Topiramate)

Depakote (Valproic Acid)

Neurontin (Gabapentin)

Anti-Depressant Medications

Pamelor (Nortriptyline)

Elavil (Amitriptyline)
Effexor (Venlafaxine)

Nardil (Phenelzine)

Muscle Relaxants
Lioresal (Baclofen)

Drugs That Affect Platelets
Aspirin

Non-Prescription Supplements
Riboflavin

Magnesium

Co-enzyme Q10

Feverfew

Injections
Botulinum Toxin (Botox)

Acute Headache Medications

These are the medications you reach for when a headache starts. They are maximally effective if taken within one hour of the onset of a headache. If a headache has been going on for several hours, it is possible these will not work so well. Often the headache will just run its course regardless of how much medication you take. Again, I suggest being very careful about how often you take these medications. Optimally they should be used no more than one time per week or five times per month.

Over-the-Counter

Acetaminophen (Tylenol)

Ibuprofen (Motrin)

Aspirin

Prescription Anti-Inflammatories
Indomethacin

Naproxen (Alleve)

Celexbrex (Celecoxib)

Mobic (Meloxicam)

Triptans
Imitrex (Sumatriptan)

Zomig (Zomatriptan)

Maxalt

Relpax

Ergotamines
DHE

Anti-Nausea Medications That Also Relieve Headaches
Thorazine

Compazine

Reglan

Phenegran (mostly used for nausea only)

Preventative Medications That I Sometimes Use

There are some medications that may prevent headaches but have either not been proven to be effective or have other contraindications.

Seroquel (Quetiapine)

Zyprexa (Olanzapine)

Zanaflex (Tizanidine) - a muscle relaxant used sometimes also in fibromyalgia

Daily Triptans the week prior to menses

Ambien ((Zolpidem) for regulation of sleep

Lidocaine injections

Medications Sometimes Used In Special Situations
I occasionally use these for headaches during treatment for rebound headache. I usually limit their use to one to two weeks.

Steroids (Prednisone)

Ativan

Ambien

Medications Used In Select Patients
(Only One to Three Times Per Month)
These medications are not appropriate for most patients. Because they so often cause the development of treatment-resistant daily headaches, I will not prescribe them to patients with more than three headaches per month. See Do Not Take These Medications For Headaches for more detail.

Medications Containing Barbiturates
Fioricet
Fiorinal

Medications Containing Caffeine
Excedrin Migraine
BC Powder
Cafergot

All Medications Containing Narcotics
(Here are a few examples)

Morphine
Codeine
Demerol

Stadol (Butorphanol)

Methadone

Ultram (Tramadol)

Percocet
Vicodin
** Note that regular use of these medications that exceeds my suggested dosage requires a second opinion and evaluation by a headache specialist in the States.

Return to Headaches

Continue to Do Not Use These Medications for Headache