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Headache Management Protocol (Migraine & Tension)

Chronic/Non-Communicable

1. Assessment & Diagnosis

  • Migraine: Unilateral, pulsating/throbbing quality, moderate to severe intensity, aggravated by routine physical activity. Associated with nausea, vomiting, photophobia (light sensitivity), or phonophobia (sound sensitivity).
  • Tension-Type Headache: Bilateral, pressing/tightening quality (non-pulsating), mild to moderate intensity. Not aggravated by physical activity and no vomiting.
  • Medication Overuse Headache: Consider this in patients with headache on ≥15 days/month who overuse acute medication (e.g., Triptans/Opioids ≥10 days/month or NSAIDs ≥15 days/month).

    • 2. Management

  • Lifestyle: Maintain regular sleep, meals, and hydration. Manage stress and identify triggers.
  • Acute Treatment (Migraine):
  • Mild-Moderate: NSAIDs (Ibuprofen, Naproxen) or Acetaminophen are first-line.
  • Severe: Triptans (e.g., Almotriptan, Rizatriptan, Sumatriptan) are recommended when NSAIDs fail. Early intake is crucial.
  • Nausea: Anti-emetics (e.g., Metoclopramide) may be added.
  • Acute Treatment (Tension-Type): Simple analgesics (Acetaminophen, NSAIDs).
  • Caution: Avoid Opioids and Butalbital-containing analgesics due to high risk of medication overuse headache.
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    Warning Signs

    "SNOOP" RED FLAGS (Refer Immediately)

  • Systemic symptoms: Fever, weight loss, or cancer history.
  • Neurologic symptoms: Confusion, weakness, seizure, or abnormal exam.
  • Onset: Sudden, abrupt, or "thunderclap" headache.
  • Older: New onset headache in patient >50 years old.
  • Pattern change: Progressive headache or change in frequency/severity.

    • Reference

    1. Werner J. Becker, MD, et al. (Canadian Family Physician) (2015). Guideline for primary care management of headache in adults.
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