Medication Therapy

Oral medications for prevention of headaches


There are a number of categories of medications used to prevent headaches and facial pain. Below are
listed the important categories with some names of medications:

Beta blockers
– Propranolol, atenolol, metopralol, nadalol
These tend to lower heart rate and blood pressure but are very well tolerated and effective.

Tricyclic antidepressants – Amitriptyline, nortriptyline, doxepin
Most of these are in fact not use much for depression but are quite useful in migraine, tension-type headache, and neuralgia. Side effects tend to be some sedation, dry mouth and possible increased appetite.

Other antidepressants - venlafaxine, duloxetine
These are a bit less useful than the tricyclics but are nonetheless effective for some.

Antiepilepsy medications – topiramate, valproate, gabapentinzonisamide
While different members of this family have different properties they can all be very effective in a number of types of head pain. Side effects vary but a common thread is a tendency to produce some mild cognitive difficulty in some patients at higher doses.

Calcium channel blockers – verapamil, amlodipine
These are sometimes effective in migraine, but can be particularly effective in cluster headaches.

Antispasmodics – baclofen, tizanidine
These are best in pain due to nerve damage or irritation like neuralgias and are generally well tolerated but sedating.


Acute medications


These are used at the time of the headache for the express purpose of reduction symptoms at the time. We not only target head pain but also nausea and vertigo.

Triptans – sumatriptan, naratriptan, rizatriptan, zolmitriptan, almotriptan, eletriptan and frovatriptan
These are mainly available in oral form, but sumatriptan has an injectable form which can be used at home, and both sumatriptan and zolmitriptan have nasal spray forms.

Non-steroidal anti-inflammatory medications (NSAIDs) – ibuprofen, naproxen, diclofenac
Mostly in pill form, these can be very effective though in general not as potent as triptans

Antiemetics – promethazine, prochlorperazine, ondansetron
Nausea often becomes more disabling than the head pain and must be treated when it is severe.These can be used in rectal suppository form and ondansetron has a very effective under-the-tongue version.


Nerve blocks and trigger point injections


Both of these approaches involves injecting anesthetic medication in the head and or neck for acute relief, or more commonly, prevention of headaches. They are done in the office and require very little preparation. The medications used include lidocaine and bupivacaine. The nerves targeted include the occipital nerves (back of the head), supraorbital nerves (forehead) and sphenopalatine ganglion nerves
(done without a needle but with a catheter carefully inserted into a nostril). Muscle we target run in mostly in the upper neck and near the jaw.