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Pharmacotherapy is the mainstay for patients with persistent headaches. When simple analgesics can no longer be used,combination analgesics are prescribed.Symptomatic medications also include antimetics,ergot derivatives.corticosteroids,neuroleptics,and narcotics.Nonsteroidal anti- inflammatory drugs are commonly used both symptomatically and prophylactically,and are the treatment of choice for menstrual migraine. Exertional migraine,benign orgasmic cephalgia chronic paroxysmal hemicrania,cough headache,and"ice-pick"headache are treated with indomethacin.Ergotamine tartrate is often recommended when simple or combination analgesics do not relieve headaches.Dihydroergotamine(DHE)is effective for treating intractable headache;because it has fewer side effects than ergotamine,it is tolerated by patients unable to tolerate other ergotamine preparations.DHE is administered IM and,for occasional use,patients can be taught self-injection.Repetitive IV DHE therapy for chronic severe headaches requires hospitalization;most patients become headache-free within three days.Patients who refuse hospitalization,do not respond to the drug,or are not suitable candidates for DHE therapy may receive a short course of corticosteroid,a neuroleptic or,rarely,a narcotic.For frequent headaches,prophylactic treatment usually begins with a tricyclic antidepressant or beta blocker. |
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