For Headache Sufferers

We assume a doctor has first diagnosed your headache type.

Click on Find my headache to find out more about symptoms and the approach to treatment (video or information sheet formats)
Look at the Treatment Tables for your particular headache- these are taken from the British Association for the Study of Headache guidelines and will help you better understand the options available
Just show me information sheets is a shortcut to all the various information sheets

You may wish to print the treatment table/information sheets to bring to a consultation

Table 3. Recommended acute treatments – simple analgesics and antiemetics

DRUG	DOSE	MAXIMUM DAILY DOSE	INFORMATION
Simple analgesics
ASPIRIN^144-148	600-1000 mg (UK doses are 300-900 mg)	4000 mg (for oral dosing)
DICLOFENAC^149-152	25 mg	150 mg
IBUPROFEN^153-155	400-600 mg	2400 mg
KETOPROFEN^156,157	75-150 mg	150 mg
NAPROXEN^158-160	250 mg	1000 mg
PARACETAMOL^133,161	1000 mg	4000 mg
TOLFENAMIC ACID¹⁶²	200 mg	400 mg
Antiemetics
DOMPERIDONE¹³³	10 mg	30 mg	Safety alert: MHRA-Domperidone
PROCHLORPERAZINE^163-165	10 mg	30 mg
METOCLOPRAMIDE^132,166,167	10 mg	30 mg	Safety alert: MHRA - Metoclopramide

Table 4. Recommended acute treatments – triptans

DRUG	FORMULATION	STRENGTH	SINGLE DOSE	MAX/24 HOURS
ALMOTRIPTAN^168,169	TABLET	12.5 mg	12.5 mg	25 mg
ELETRIPTAN¹⁷⁰	TABLET	40 mg	40 mg	80 mg
FROVATRIPTAN¹⁷¹	TABLET	2.5 mg	2.5 mg	5 mg
NARATRIPTAN¹⁷²	TABLET	2.5 mg	2.5 mg	5 mg
RIZATRIPTAN¹⁷³	TABLET ORODISPERS LYPOPHILLISATE	5 mg/10 mg 10 mg 10 mg	10 mg 10 mg 10 mg	20 mg 20 mg 20 mg
SUMATRIPTAN^137,174	TABLET SPRAY SUBCUT INJ	50 mg/100 mg 100 mg/ml or 200 mg/ml 6 mg	50-100 mg 10 - 20 mg 6 mg	300 mg 12 mg
ZOLMITRIPTAN^175-177	TABLET ORODISPERS SPRAY	2.5 mg/5 mg 2.5 mg/ 5 mg 50 mg/ml	5 mg 5 mg 5 mg	10 mg 10 mg 10 mg

Table 5. Recommended preventive treatments in episodic and chronic migraine

DRUG	START DOSE	TITRATION	TRIAL STUDIED DAILY DOSES
Amitriptyline^187-191	10-25 mg OD	10 -25 mg	25-150 mg
Candesartan^192,193	2 mg OD	2 mg	8-16 mg total/day
Propranolol^187,194,195	10 mg BD	10-20 mg BD	120-240 mg total/day
Topiramate^196-205	25 mg daily	25 mg od	25-200 mg total/day
CGRP monoclonal antibodies
Erenumab^206-209	70-140 mg monthly	Max dose as per licensed indication
Fremanezumab²¹⁰	225 mg monthly 675 mg three-monthly	Max dose as per licensed indication
Galcanezumab^211-213	120-240 mg monthly	Max dose as per licensed indication

Table 6. Recommended preventive treatments for chronic migraine only

Onabotulinumtoxin A214-218

155-195 IU intramuscularly, as per PREEMPT protocol

Every 12 weeks

Table 7. Recommended triptans for short term prevention of menstrual related migraine or pure menstrual migraine

DRUG	FORMULATION	STRENGTH
FROVATRIPTAN^255,256	TABLET	2.5 mg twice daily on the days migraine is expected (generally from two days before until three days after bleeding starts).
ZOLMITRIPTAN²⁵⁷	TABLET	2.5 mg twice or three times a day on the days migraine is expected (generally from two days before until three days after bleeding starts).

Table 8. Recommended acute treatments in tension-type headache

ANALGESIC	SINGLE DOSE	MAXIMUM DAILY DOSE
Paracetamol^321-323	1000 mg	4000 mg
Aspirin^324,325	500-1000 mg (UK doses are 300-900 mg)	4000 mg (for oral dosing)

Table 9. Recommended preventive treatment in tension-type headache

DRUG	STARTING DOSE	TITRATION	MAXIMUM DOSE
Amitriptyline^326-330	10 mg	10-25 mg	150 mg

Table 10. Recommended Acute Cluster attack treatments

Treatment	Formulation	Strength	Maximum Daily Dose
Oxygen^373,374	Inhalation through non-rebreathable mask	7-15 L/min	No limit
Sumatriptan³⁶⁸	Subcutaneous injection	6 mg	12 mg
Sumatriptan³⁷⁵	Nasal spray	20 mg	40 mg
Zolmitriptan^376-378	Nasal spray	5 mg	15 mg
Non-invasive vagal nerve stimulation³⁷⁹	Transcutaneous	As per specialist recommendation

Table 11: Recommended preventive treatments for cluster headaches

Name	Start dose	Titration	Max daily dose	Comments
Greater occipital nerve block^388,389	Depot steroid + local anaesthetic	Not applicable	Not applicable	Different formulations of steroid & anaesthetic used*
Verapamil³⁸⁴	80 mg TDS	Increase 80 mg every 2 weeks	960 mg	ECG monitoring recommended

*There does not seem to be a difference between different local anaesthetics

General Headache Information
Headache Self Help		What you can do to help yourself and help your doctor.
Headache Diary		Headache sufferers can use this diary to keep a track of how often they have headaches and how severe they are.
Brain Scans		When are brain scans needed for a headache?
Incidental Findings		This is a guide to the phenomenon of 'incidental findings' - discoveries on scans that the doctors were not looking for.

Migraine Information
Migraine Overview		What is migraine and how common is it?
Migraine Symptoms		Guide to common symptoms of migraine
Migraine Attack Treatment		How to treat migraine attacks when they happen
Migraine Preventive Treatment		Treatments that can prevent migraine attacks starting.
Menstrual Migraine		Menstrual migraine treatment options.
Migraine in Pregnancy and Breastfeeding		Migraine treatment options during and after pregnancy.
Migraine and Stroke Risk		Information about how migraine affects the chances of having a stroke.

Cluster Headache Information
Cluster Headache Overview		What is cluster headache and how common is it?
Cluster Headache Symptoms		Guide to common symptoms of cluster headache
Cluster Headache Attack Treatment		How to treat cluster headache attacks when they happen
Cluster Headache Preventive Treatment		Treatments that can prevent cluster headache attacks starting.

Other Headache Information
Tension Headache		A guide to tension type headache
Medication Overuse Headache		A guide to medication oversue headache
Paroxysmal Hemicrania		A guide to paroxysmal hemicrania
Hemicrania Continua		A guide to hemicrania continua
SUNCT / SUNA		A guide to SUNCT and SUNA

Medication / Injection Information
Amitriptyline		A guide to amitriptyline use for migraine
Candersartan		A guide to candersartan use for migraine
Propranolol		A guide to propranolol use for migraine
Topiramate		A guide to topiramate use for migraine
Triptans		A guide to using triptans for migraine
Verapamil		A guide to verapamil use for cluster headache
Greater Occipital Nerve Block		A guide to GON block for headache
'Botox' (botulinum toxin) injection		A guide to botox injections for chronic migraine

Table 3. Recommended acute treatments – simple analgesics and antiemetics

DRUG	DOSE	MAXIMUM DAILY DOSE	INFORMATION
Simple analgesics
ASPIRIN^144-148	600-1000 mg (UK doses are 300-900 mg)	4000 mg (for oral dosing)
DICLOFENAC^149-152	25 mg	150 mg
IBUPROFEN^153-155	400-600 mg	2400 mg
KETOPROFEN^156,157	75-150 mg	150 mg
NAPROXEN^158-160	250 mg	1000 mg
PARACETAMOL^133,161	1000 mg	4000 mg
TOLFENAMIC ACID¹⁶²	200 mg	400 mg
Antiemetics
DOMPERIDONE¹³³	10 mg	30 mg	Safety alert: MHRA-Domperidone
PROCHLORPERAZINE^163-165	10 mg	30 mg
METOCLOPRAMIDE^132,166,167	10 mg	30 mg	Safety alert: MHRA - Metoclopramide

Table 4. Recommended acute treatments – triptans

DRUG	FORMULATION	STRENGTH	SINGLE DOSE	MAX/24 HOURS
ALMOTRIPTAN^168,169	TABLET	12.5 mg	12.5 mg	25 mg
ELETRIPTAN¹⁷⁰	TABLET	40 mg	40 mg	80 mg
FROVATRIPTAN¹⁷¹	TABLET	2.5 mg	2.5 mg	5 mg
NARATRIPTAN¹⁷²	TABLET	2.5 mg	2.5 mg	5 mg
RIZATRIPTAN¹⁷³	TABLET ORODISPERS LYPOPHILLISATE	5 mg/10 mg 10 mg 10 mg	10 mg 10 mg 10 mg	20 mg 20 mg 20 mg
SUMATRIPTAN^137,174	TABLET SPRAY SUBCUT INJ	50 mg/100 mg 100 mg/ml or 200 mg/ml 6 mg	50-100 mg 10 - 20 mg 6 mg	300 mg 12 mg
ZOLMITRIPTAN^175-177	TABLET ORODISPERS SPRAY	2.5 mg/5 mg 2.5 mg/ 5 mg 50 mg/ml	5 mg 5 mg 5 mg	10 mg 10 mg 10 mg

Table 5. Recommended preventive treatments in episodic and chronic migraine

DRUG	START DOSE	TITRATION	TRIAL STUDIED DAILY DOSES
Amitriptyline^187-191	10-25 mg OD	10 -25 mg	25-150 mg
Candesartan^192,193	2 mg OD	2 mg	8-16 mg total/day
Propranolol^187,194,195	10 mg BD	10-20 mg BD	120-240 mg total/day
Topiramate^196-205	25 mg daily	25 mg od	25-200 mg total/day
CGRP monoclonal antibodies
Erenumab^206-209	70-140 mg monthly	Max dose as per licensed indication
Fremanezumab²¹⁰	225 mg monthly 675 mg three-monthly	Max dose as per licensed indication
Galcanezumab^211-213	120-240 mg monthly	Max dose as per licensed indication

Table 6. Recommended preventive treatments for chronic migraine only

Onabotulinumtoxin A214-218

155-195 IU intramuscularly, as per PREEMPT protocol

Every 12 weeks

Table 7. Recommended triptans for short term prevention of menstrual related migraine or pure menstrual migraine

DRUG	FORMULATION	STRENGTH
FROVATRIPTAN^255,256	TABLET	2.5 mg twice daily on the days migraine is expected (generally from two days before until three days after bleeding starts).
ZOLMITRIPTAN²⁵⁷	TABLET	2.5 mg twice or three times a day on the days migraine is expected (generally from two days before until three days after bleeding starts).

Table 8. Recommended acute treatments in tension-type headache

ANALGESIC	SINGLE DOSE	MAXIMUM DAILY DOSE
Paracetamol^321-323	1000 mg	4000 mg
Aspirin^324,325	500-1000 mg (UK doses are 300-900 mg)	4000 mg (for oral dosing)

Table 9. Recommended preventive treatment in tension-type headache

DRUG	STARTING DOSE	TITRATION	MAXIMUM DOSE
Amitriptyline^326-330	10 mg	10-25 mg	150 mg

Table 10. Recommended Acute Cluster attack treatments

Treatment	Formulation	Strength	Maximum Daily Dose
Oxygen^373,374	Inhalation through non-rebreathable mask	7-15 L/min	No limit
Sumatriptan³⁶⁸	Subcutaneous injection	6 mg	12 mg
Sumatriptan³⁷⁵	Nasal spray	20 mg	40 mg
Zolmitriptan^376-378	Nasal spray	5 mg	15 mg
Non-invasive vagal nerve stimulation³⁷⁹	Transcutaneous	As per specialist recommendation

Table 11: Recommended preventive treatments for cluster headaches

Name	Start dose	Titration	Max daily dose	Comments
Greater occipital nerve block^388,389	Depot steroid + local anaesthetic	Not applicable	Not applicable	Different formulations of steroid & anaesthetic used*
Verapamil³⁸⁴	80 mg TDS	Increase 80 mg every 2 weeks	960 mg	ECG monitoring recommended

*There does not seem to be a difference between different local anaesthetics

Table 3. Recommended acute treatments – simple analgesics and antiemetics

Table 4. Recommended acute treatments – triptans

Table 5. Recommended preventive treatments in episodic and chronic migraine

Table 6. Recommended preventive treatments for chronic migraine only

Table 7. Recommended triptans for short term prevention of menstrual related migraine or pure menstrual migraine

Table 8. Recommended acute treatments in tension-type headache

Table 9. Recommended preventive treatment in tension-type headache

Table 10. Recommended Acute Cluster attack treatments

Table 11: Recommended preventive treatments for cluster headaches

General Headache Information

Migraine Information

Cluster Headache Information

Other Headache Information

Medication / Injection Information

Table 3. Recommended acute treatments – simple analgesics and antiemetics

Table 4. Recommended acute treatments – triptans

Table 5. Recommended preventive treatments in episodic and chronic migraine

Table 6. Recommended preventive treatments for chronic migraine only

Table 7. Recommended triptans for short term prevention of menstrual related migraine or pure menstrual migraine

Table 8. Recommended acute treatments in tension-type headache

Table 9. Recommended preventive treatment in tension-type headache

Table 10. Recommended Acute Cluster attack treatments

Table 11: Recommended preventive treatments for cluster headaches