Treatments and drugs

By Mayo Clinic Staff

Treatment for any underlying diseases or conditions often stops frequent headaches. When no underlying diseases or conditions are present, treatment focuses on preventing the pain before it starts.

Specific prevention strategies vary, depending on which type of headache you have and whether medication overuse is contributing to these headaches. If you're taking pain relievers more than three days a week, the first step in treatment may be to stop using these drugs. When you're ready to begin preventive therapy, your doctor may recommend:

  • Antidepressants. Tricyclic antidepressants — such as nortriptyline (Pamelor, Aventyl Hydrochloride) — can be used to treat chronic headaches. These medications can also help treat the depression, anxiety and sleep disturbances that often accompany chronic daily headaches. Other antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac, Sarafem), may be helpful for treatment of depression and anxiety, too.
  • Beta blockers. These drugs, commonly used to treat high blood pressure, are also a mainstay for preventing episodic migraines. Some beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) and propranolol (Inderal, Innopran XL). Sometimes beta blockers are prescribed in combination with antidepressants, and this combination is sometimes more effective than either medication on its own.
  • Anti-seizure medications. Some anti-seizure drugs seem to prevent migraines. These medications may be used to prevent chronic daily headaches as well. Options may include gabapentin (Neurontin, Gralise), topiramate (Topamax) and divalproex sodium (Depakote).
  • NSAIDs. Prescription nonsteroidal anti-inflammatory drugs — such as naproxen (Anaprox, Naprosyn, Naprelan) — may be helpful, especially if you're going through withdrawal from other pain relievers. They may also be used periodically when the headache is more severe.
  • Botulinum toxin. Botulinum toxin type A (Botox) injections provide relief for some people and may especially be a viable option for people who don't tolerate daily medication well.

Unfortunately, some chronic daily headaches remain resistant to all medications.

Mar. 15, 2012

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