Pharmacology and use of headache medications

Treatment of headache disorders is most likely to be successful when the pathophysiology of the disease is correlated with the pharmacologic actions of the available drugs. Beta blockers generally are considered first-line therapy for migraine prophylaxis, but calcium blockers also are appropriate for some patients. Antidepressants are the primary modality for treatment of tension type headaches, although they are also used for migraine prophylaxis. Mixed headache, which has features of both migraine and tension-type headache, usually requires treatment with more than one drug. Habituation to analgesics is common among patients with mixed headache.