Management – Overview

The management approach for acute headache involves a dual focus – providing optimal symptomatic relief while concurrently screening for and managing any dangerous secondary causes.

General principles include:

• Target headache relief to return patient to normal function with minimal adverse effects
• For primary headaches, start with non-pharmacological therapies like hydration, rest, and avoidance of headache triggers
• Select pharmacological agents based on headache severity and prior treatment response
  • Mild: acetaminophen, NSAIDs, caffeine
  • Moderate to severe: triptans, antiemetics, ergot derivatives
  • Status migrainosus: corticosteroids, intravenous fluids, antiemetics, neuroleptics

• Address contributing factors like stress, poor sleep, and medication overuse
• Educate on lifestyle modifications to reduce headache burden
• Have high suspicion for secondary headaches based on red flag symptoms
• Perform focused diagnostic workup for suspected secondary cause
• Provide expedited management when dangerous secondary cause identified
  • Neuroimaging, neurosurgical intervention
  • Targeted antimicrobial therapy
  • Corticosteroids for inflammatory causes

• Arrange outpatient follow up to optimize preventive headache care

A thoughtful approach evaluates both primary headache control and possibility of emergent secondary disorders. Pharmacists have a vital role in tailored symptom relief and vigilance for red flag workup.