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When assessing a patient who is experiencing headache for the first time, MTM providers should ask appropriate questions to determine the type of headache (eg, tension or migraine).

MTM providers should assess whether a patient has underlying conditions that may contribute to headache, and refer patients for whom headache may be a symptom of a more serious problem (eg, severely elevated blood pressure).

When possible, MTM providers should encourage patients experiencing moderate to severe migraine to take migraine-specific medications, such as a triptan, for relief of pain. These are more effective than analgesic pain relievers for migraine headache.

MTM providers should educate patients taking triptans to take these agents as soon as possible at the start of migraine pain for maximal effect.

MTM providers should stay alert for patients who have frequent, very severe, or long-lasting migraine headaches. These patients may benefit from preventive therapy to decrease migraine frequency or severity.


Headache is a pain that arises from either the neck or head. Headaches are generally classified as being 1 of 3 types: migraine, tension, or cluster. These types can be subdivided further, and each type has defined treatment options. Information presented in this chapter will focus on migraine treatment, because this headache type has a significant number of pharmacotherapy treatment options and is encountered relatively frequently in practice (Table 24-1).

Table 24-1.International Headache Society Classification System: Focus on Migraine Headache1

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