Lifestyle measures

  • Maintain good hydration > 2 litre of fluids/day
  • Avoid skipping meals
  • Good regular sleep hygiene, aim for 6-8hours a night
  • Regular exercise, at least 30min/day of brisk walking x3/week
  • Reduce caffeine intake to a minimum. Preferably have decaffeinated coffee/tea
  • Limit intake of alcohol
  • Take measure to reduce current stress triggers Acute analgesia:
  • Taking any form of analgesia (including paracetamol, codeine, ibuprofen) on more than 10 days/ month can lead to ‘analgesia overuse’ ( makes headaches worse). It is the frequency of taking this medication rather than the number of tablets within a day that contributes to this effect. Whilst doing this, the headaches will get worse for 2 weeks then improvement should be seen.

For acute headaches, try the following options

  • 1st Line
    • Naproxen 500mg bd with metoclopramide 10mg ( if nauseous)
    • Ibuprofen 600mg ( max 1200mg/day) with metoclopramide 10mg ( if nauseous)  Aspirin 900mg with Metoclopramide 10mg ( if nauseous)
  • 2nd Line
    • Sumatriptan: 50 – 100mg oral od or 6mg subcutaneous
    • Almotriptan 12.5mg oral od
    • Zolmitriptan 2.5mg – 5mg oral od
    • Rizatriptan 10mg oral od ( if in beta blocker, use 5mg oral od)
    • Eletriptan 40-80mg oral od
  • Use these in combination with Metoclopramide 10mg
  • Contraindicated in coronary artery disease or cerebrovascular disease, peripheral vascular disease, uncontrolled hypertension, concomitant use SNRI, SSRI or MAOI
  • Consider using sublingual formulation if nausea is significant

Medication for prevention

  • For the choice given, the goal is to start at a low dose, titrate up slowly to a therapeutic dose then keep at the dose for at least 3 months unless having side effects
  • It can onlt be deemed to be a failed treatment if there is no effect after 3 months or is not tolerated and the patient must not be having concurrent analgesia overuse


rizatriptan eletriptan sumatriptan zolmitriptan Naproxen Ibuprofen Almotriptan

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