Headaches

Primary Headaches

These are not caused by another condition — the headache itself is the main problem.

Tension Headache
Most common type
Pain: Mild to moderate, dull, pressing/tightening, like a band around the head
Location: Both sides of the head, forehead, or back of neck
Triggers: Stress, poor posture, fatigue

Migraine
Pain: Moderate to severe, throbbing or pulsing
Location: Usually one side of the head
Other symptoms: Nausea, vomiting, sensitivity to light and sound, visual disturbances (auras)
Duration: 4–72 hours
Triggers: Hormones, certain foods, stress, lack of sleep

Cluster Headache
Pain: Severe, sharp/stabbing
Location: One side of the head, often around or behind one eye
Other symptoms: Red, teary eye, nasal congestion, restlessness
Timing: Comes in “clusters” — daily attacks for weeks/months, often at the same time of day

2. Secondary Headaches

These are symptoms of an underlying medical condition.

Sinus Headache

Pain: Pressure in forehead, cheeks, or around eyes
Other symptoms: Sinus congestion, facial swelling, fever
Cause: Sinus infection (sinusitis)

Medication Overuse Headache (Rebound Headache) (MOH)

Pain: Daily or near-daily, varies in intensity
Cause: Frequent use of headache medications (painkillers, triptans, etc.)

Cervicogenic Headache

Pain: Starts in the neck and radiates to head
Cause: Neck injury, arthritis, poor posture

Thunderclap Headache

Pain: Sudden, severe, “worst headache of your life”
Medical emergency: Can signal bleeding in the brain (aneurysm, stroke)

Post-Traumatic Headache

Pain: Varies
Cause: Follows head injury or concussion
May include: Dizziness, trouble concentrating

3. Cranial Neuralgias & Facial Pain

These involve nerve inflammation or irritation.
Trigeminal Neuralgia

Pain: Sudden, severe, electric-shock-like pain in the face
Trigger: Touching the face, brushing teeth, chewing

Headache Types: Symptoms & Treatment Chart

Functional Medicine Additional Treatments For Headaches

Reduce inflammatory food
Reduce liver and gall bladder inflammation
Reduce consumption of processed food
Acupuncture
Chinese Herbs to reduce stagnation
Lose weight
Reduce high blood pressure
Reduce elevated blood sugar

Types of Medication – Rescue vs Management

While several over-the-counter and prescription medications can treat migraine, not all are good at easing symptoms like head pain, nausea, vomiting, and sensitivity to light that can last a few hours or a few days.
For the 36 million Americans who have migraine, treating the symptoms is one part of the battle: Another critical goal is preventing the painful headaches, and there hasn’t been a medication for that. Until now.
In 2018, the FDA approved the first calcitonin gene-related peptide (CGRP) inhibitors. These new drugs are designed to prevent episodic migraine (up to 14 headache days per month), chronic migraine (15 headache days per month or more), and medication overuse headaches. CGRP inhibitors were the first class of drugs developed to prevent migraines with or without visual auras. Experts recommend their use for those with 6 or more migraine days per month, or when older preventive migraine treatments fail or are not tolerated by the migraine sufferer.

Types of Rescue Medications for Migraines

1. Triptans – Migraine-specific These are often first-line rescue drugs
Sumatriptan (Imitrex) Rizatriptan (Maxalt) Zolmitriptan (Zomig) Eletriptan (Relpax)
How they work: Constrict blood vessels and block pain pathways in the brain
Forms: Pills, nasal sprays, injections.
2. Ditans – Newer option for those who can’t take triptans
Example: Lasmiditan (Reyvow)
How they work: Acts on serotonin receptors without constricting blood vessels.
Useful for: People with cardiovascular risk who can’t take triptans.
3. Gepants – New oral CGRP receptor blockers
Rimegepant (Nurtec ODT) Ubrogepant (Ubrelvy)
How they work: Block CGRP (a protein involved in migraine pain). Fast acting and well tolerated.
4. NSAIDs and Other Pain Relievers Ibuprofen (Advil) Naproxen (Aleve) Aspirin Acetaminophen (Tylenol) — less effective than NSAIDs for migraines Often combined with caffeine (e.g., Excedrin Migraine)
5. Ergots – Older class, used less now
Dihydroergotamine (DHE 45, Migranal nasal spray) Used when: Triptans are not effective or tolerated.
6. Anti-nausea (antiemetic) drugs – For migraine with nausea Metoclopramide (Reglan) Prochlorperazine (Compazine) Ondansetron (Zofran)
7. Steroids – For prolonged or severe migraines (status migrainosus)
Dexamathasone – Often given in ER settings to break the cycle.
8. Combination Medications
Fioricet (acetaminophen, butalbital, caffeine) Fiorinal (aspirin, butalbital, caffeine)
Caution: Risk of dependency and rebound headaches.
Rescue medications should not be used too frequently (e.g., >10 days/month for triptans or NSAIDs), as they can cause medication-overuse headaches (MOH).
A healthcare provider may tailor your rescue plan based on:
Severity and duration of your migraines Underlying health conditions (e.g., heart disease) Medication side effects Prior treatment response

Types of Preventive Migraine Medications

1. CGRP Monoclonal Antibodies – Newest class, migraine-specific
Erenumab (Aimovig) – once monthly injection Fremanezumab (Ajovy) – monthly or quarterly injection Galcanezumab (Emgality) Eptinezumab (Vyepti) – IV every 3 months
How they work: Block CGRP, a molecule involved in migraine pathways
Pros: Highly targeted, well tolerated, few side effects
2. Oral CGRP Blockers (Preventive Gepants) – Dual-use meds
Rimegepant (Nurtec ODT) – every other day Atogepant (Qulipta) – daily
Note: These can sometimes be used both as rescue and preventive
3. Beta Blockers – Heart meds used for migraine too
Propranolol Metoprolol Atenolol
Caution: Can lower blood pressure and heart rate.
4. Antidepressants – Especially helpful if depression/anxiety
Amitriptyline (Elavil) Nortriptyline Venlafaxine (Effexor XR)
Common side effect: Drowsiness (may help sleep)
5. Anti-seizure Medications
Topiramate (Topamax) Valproic acid (Depakote)
Effective but may have cognitive or mood-related side effects.
6. Calcium Channel Blockers – Often used for migraine with aura
Verapamil
May also help with blood pressure and heart rhythm.
7. Botox Injections – For chronic migraine (≥15 headache days/month)
Botulinum toxin A (Botox) injected in head/neck every 12 weeks
FDA-approved specifically for chronic migraine
8. Natural Supplement Options – less potent
Magnesium (400–600 mg/day) Riboflavin (Vitamin B2) (400 mg/day) Coenzyme Q10 (100 mg 3x/day) Butterbur or Feverfew (herbal options—consult doctor first)

The right preventive depends on:
Your migraine pattern
Other health conditions (e.g., blood pressure, mood)
Potential side effects
Ease of use (daily pill vs monthly shot)