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Update Summary

August 8, 2023

The following sections and tables were updated:


For the Chapter in the Schwinghammer Handbook, please go to Chapter 55, Headache: Migraine and Tension-Type.



image Acute migraine therapies should provide consistent, rapid relief, and enable the individual to resume normal activities at home, school, or work.

image The selection of initial treatment is based on headache-related disability, symptom severity, and preference for the individual with migraine.

image Strict adherence to maximum daily and weekly doses of anti-migraine medication is essential.

image Preventive therapy should be considered for recurring migraine attacks that produce significant disability; frequent attacks requiring symptomatic medication more than twice per week; symptomatic therapies that are ineffective, contraindicated, or produce serious adverse effects; and uncommon migraine variants that cause profound disruption and/or risk of neurologic injury.

image The selection of an agent for headache prophylaxis should be based on individual response, tolerability, convenience of the medication formulation, and coexisting conditions.

image Each prophylactic medication should be given an adequate therapeutic trial (usually 6 months) to judge its maximal efficacy.

image A general wellness program that considers headache triggers should be included in the management plan.

image After an effective abortive agent and dose have been identified, subsequent treatments should begin with that same regimen.



Read the article by Vandenbussche N, Laterza D, Lisicki M, et al.1

Review other existing literature related to whether medication-overuse headache is a distinct entity. Summarize two key points on both the pro and con sides of the issue. Be prepared to discuss or debate in class. (Note to instructors: It would be a good opportunity to assign teams and have an in-class discussion or formal debate.)


Headache is among the top five principal reasons adults 18 to 44 years of age visit US emergency departments and are one of the most common complaints encountered by healthcare practitioners.2 They can be symptomatic of a distinct pathologic process or can occur without an underlying cause. In 2018, the International Headache Society (IHS) updated its classification system and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain.3 The IHS classification provides more precise definitions and standardized nomenclature for both the primary (migraine, tension-type, and cluster headache) and secondary (symptomatic of organic disease) headache disorders. These criteria are designed to facilitate headache diagnosis in clinical practice, as well as being used for research. This chapter focuses on the management of primary headache disorders.

Most recurrent headaches result from a benign chronic primary headache ...

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