Headache subtypeDiagnostic criteriaNonpharmacologic treatment optionsPharmacologic treatment options
Tension-type≥ 10 headaches lasting 30 minutes to 7 days plus two of the following:
 Mild to moderate severity
 Squeezing, tightening quality
 Bilateral/global symptoms
Typically not associated with nausea, vomiting, or autonomic symptoms
Physical therapyAcute relief:
 Acetaminophen, ibuprofen
Preventive:
 Amitriptyline
MigraineEpisodic: < 15 headache days in 30 days
Chronic: ≥ 15 headache days in 30 days
≥ 5 headaches lasting 4 to 72 hours plus two of the following:
 Moderate to severe intensity
 Unilateral symptoms
 Throbbing, pulsating quality
 Nausea, photophobia, and/or phonophobia
 Aggravated by activity
Dietary trigger avoidanceAcute relief:
 Nonsteroidal anti-inflammatory drugs
 Triptans (frovatriptan [Frova], rizatriptan [Maxalt], sumatriptan [Imitrex], naproxen/sumatriptan [Treximet], zolmitriptan [Zomig]
Preventive:
 Angiotensin-converting enzyme inhibitor (lisinopril)
 Angiotensin receptor blocker (candesartan [Atacand], telmisartan [Micardis])
 Calcitonin gene-related peptide receptor inhibitors (erenumab [Aimovig], fremanezumab [Ajovy], galcanezumab [Emgality])
 Magnesium (oral)
 OnabotulinumtoxinA (Botox; only for chronic migraine [> 15 days per month])
 Propranolol
 Topiramate (Topamax)
Cluster≥ 5 severe or very severe orbital or temporal headaches lasting 15 to 180 minutes and recurring every other day to 8 times per day plus either:
 Ipsilateral autonomic features
or
 Restlessness/agitation
Preventive:
 Noninvasive vagus nerve stimulation
Preventive:
 Galcanezumab
General headacheIncludes primary and secondary headache disordersAerobic exercise
and progressive strength training
Mindfulness-based
therapy
Pharmacologic options are based on subtype