Headaches or cephaleas can basically be of two types: primary cephaleas (the cephalea itself is the disease because there is no injury that produces it) and secondary cephaleas (the headache is due to a banal or serious injury that produces it, for example: a flu; a tumor; a blow, etc.). Logically, treatment in the neurology specialty will depend on whether it is primary or secondary.
The most common are primary headaches: tension headache (due to stress, worries, etc.) and migraines or migraine headaches.
The treatment of tension headaches can improve with various relaxation techniques and an occasional ordinary analgesic, but if they become chronic due to analgesic abuse, treatment with a mild antidepressant such as amitriptyline 10 mg/24h for one or two months continuously and withdrawal of analgesic abuse can be beneficial.
The treatment of migraines is somewhat more complex and specific. Fundamentally, it is necessary to decide (based on the frequency, intensity and response to pain-relieving treatment) whether to use preventive and pain-relieving treatment or only pain-relieving treatment.
- Preventive treatment of migraine would be taken daily orally for months, the most commonly used at present are: topiramate; flunarizine; propranolol. Recently and in extreme cases of frequency and lack of response to these treatments, botulinum toxin injected every three months is being used, with good results.
- Triptan type drugs (almotriptan; rizatriptan; eletriptan; sumatriptan etc.) are the most specific, best performing and safest treatment for immediate pain relief. Do not wait to take it when the pain has been present for a long time (hours) or is already too strong because the results will be worse. On the other hand, if the pain is mild, regular analgesics such as NSAIDs (naproxen or others) can also be used. Sometimes they are associated with an antiemetic (domperidone) for vomiting.