General principles of treatment of headaches

1. Big picture

The first rule in treating headache is:

Do not treat every headache as “just pain.” First decide whether it is primary or secondary.

A primary headache is the disease itself, such as migraine, tension-type headache, or cluster headache. In these cases, treatment is directed at the headache syndrome.

A secondary headache is a symptom of another disease, such as subarachnoid hemorrhage, meningitis, tumor, venous sinus thrombosis, temporal arteritis, glaucoma, trauma, or hypertensive crisis. In these cases, treatment is directed at the underlying cause, not only pain relief.

The key exam sentence:

In symptomatic headache, treat the cause; in idiopathic primary headache, use attack treatment, and if attacks are frequent or disabling, add prophylactic treatment.

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