When assessing a patient who is experiencing headache for the first time, it is important to ask appropriate questions to determine the type of headache (eg, tension, migraine).
Medication therapy management (MTM) providers should assess for any underlying conditions that may contribute to headache, and refer patients in whom a 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 “triptans” for relief of pain. These medications are more effective than analgesic pain relievers for migraine headache.
MTM providers should educate patients to take triptans 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 the head. In 2013, the International Headache Society (IHS) updated its classification system and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain.1 The IHS classifies headache into two categories: primary (migraine, tension-type, and cluster headache) and secondary (symptomatic of organic disease) headache disorders.
Migraines affect more women than men in adulthood. Adults between the ages of 30 and 39 years have the highest incidence of migraine headache. Economically, migraines cost 13 billion dollars per year because of missed workdays and lower productivity.1,2 Similar to migraines, tension-type headaches are more common in women than men and have the highest incidence in patients in their fourth decade of life. Cluster headaches are uncommon, but can be extremely severe, with acute attacks, or “cluster” periods, that can last weeks and up to months. Unlike migraines and tension headaches, cluster headaches are more common in men and occur in the third to fifth decade of life.1,2 Information presented in this chapter will focus on migraine treatment, as this headache type has a significant number of available pharmacotherapy options and is encountered relatively frequently in practice (Table 24-1).
TABLE 24-1International Headache Society Classification System: Focus on Migraine Headache |Favorite Table|Download (.pdf) TABLE 24-1 International Headache Society Classification System: Focus on Migraine Headache
|Migraine without aura |
|Migraine with aura |
| Migraine with typical aura (lasting <1 hour) with or without headache |
|Migraine with brainstem aura |
| Hemiplegic migraine (familial, sporadic) |
| Retinal migraine (repeated attacks of monocular visual disturbance) |
|Chronic migraine (occurring on ≥15 days/month for >3 months) |
|Complications of migraine |
| Status migrainous (debilitating attack lasting for >72 hours) |
| Persistent aura without infarction (symptoms persisting for >1 week) |
| Migrainous infarction (aura symptoms associated with an ischemic brain lesion) |
| Migraine aura-triggered seizure |
|Probable migraine with or without aura |
|Episodic syndromes that may be associated with migraine |
| Recurrent gastrointestinal (GI) disturbance ...|