Drugs used to treat headaches generally fall into one of three broad categories:
Each drug used to treat headaches has its own particular advantages and disadvantages. It may not be possible to predict which drug will work best for your headaches. By understanding the general principles, you and your health-care provider can better choose which one to try first. If the first drug does not work or causes bothersome side effects, a trial-and-error approach may be necessary.
Abortive drugs are used to stop (abort) a headache once it begins. These drugs tend to work best when taken right at the beginning of a headache. Abortive drugs can be extremely effective for migraine and cluster headaches, but they tend not to work for the more common tension-type headaches. Abortive drugs also lose their effectiveness when used too often (for example, more than three times per week), so they generally are not given to people who suffer from daily headaches. Examples of abortive drugs include the triptans (such as sumatriptan) and ergot alkaloids (such as ergotamine).
Preventive (or prophylactic) drugs are used to prevent headaches from occurring. These drugs are usually taken daily, whether a headache is present or not. Preventive drugs often are started for an indefinite period, but they may be tapered slowly if headaches come under good control. It is important to recognize that preventive drugs may not completely eliminate headaches. However, the right drug will:
- Reduce the number and frequency of headaches
- Improve the quality of life for people who suffer from severe headaches
- Reduce the need for pain-relieving drugs, especially for people who require these drugs frequently
Examples of preventive drugs include tricyclics (such as amitriptyline), anticonvulsants (such as valproate) and beta-blockers (such as propranolol).
Pain relievers, or analgesics, treat the pain of headaches. These drugs usually are taken once a headache has started. Pain relievers generally do not prevent headaches, nor do they truly stop a headache that has started. However, many headache sufferers find that pain relievers are the only treatment that is ever needed. A variety of prescription and over-the-counter pain relievers are available, including acetaminophen (Tylenol), aspirin, nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen), barbiturates (such as butalbital) and narcotics.