26 June 2004
National Headache Foundation - Private Nonprofit Organization
Summary,

GUIDELINE OBJECTIVE(S)

* To improve the medical treatment of headache
* To help physicians and other health care professionals to:
o Rule out secondary headache and establish a primary headache diagnosis
o Set reasonable goals with each patient, identifying expectations and individual needs by tailoring the educational component to the patient's level of active participation and desire
o Design a treatment plan, combining nonpharmacologic with pharmacologic approaches as necessary to:
+ Minimize symptomatology
+ Reduce disability
+ Improve quality of life
o Provide follow-up care for long-term headache management to:
+ Reassess how well the treatment plan is achieving established goals
+ Reevaluate patient needs and specific headache patterns
o Recognize indications for appropriate and timely referrals to specialists

TARGET POPULATION

Patients with chronic daily headache (CDH)

INTERVENTIONS AND PRACTICES CONSIDERED

General Management Strategies

1. Patient education and involvement in treatment plan
2. Early consultation with headache specialist
3. Screening and counseling patients for medication overuse
4. Stopping or tapering medication that is being overused
5. Providing measures to cover the withdrawal headache that will ensue upon stopping the overused medication
* Clonidine (for opioid withdrawal)
* Temporary substitution of phenobarbital for butalbital (to avoid seizures or other serious withdrawal symptoms)
* Intravenous (IV) dihydroergotamine (DHE) (for headache relief)

Pharmacologic Treatments

1. Acetazolamide
2. Amitriptyline
3. Botulinum toxin type A
4. Divalproex sodium
5. Doxepin
6. Fluoxetine
7. Indomethacin
8. Nefazodone
9. Phenelzine
10. Tizanidine
11. Topiramate
12. Glucocorticoids, including dexamethasone, prednisone, methylprednisolone
13. Dihydroergotamine
14. Caffeine
15. Codeine
16. Oxycodone
17. Butalbital
18. Propoxyphene
19. Butorphanol
20. Ergotamine tartrate
21. Almotriptan
22. Eletriptan
23. Sumatriptan succinate
24. Naratriptan
25. Rizatriptan benzoate
26. Zolmitriptan
27. Metoclopramide
28. Chlorpromazine
29. Valproate
30. Ketorolac

Other Treatments

1. Nerve blocks
2. Trigger point injections
3. Injections of botulinum toxin
4. Inpatient treatment

Nonpharmacologic Treatments

1. Biofeedback
2. Stress management
3. Cognitive behavioral therapy

MAJOR OUTCOMES CONSIDERED

Not stated