Managing headache in primary care: choosing therapies that treat the whole patient

To provide a practical, comorbidity-aligned approach to headache management in primary care, emphasising therapies that can address headache and coexisting chronic conditions while reducing polypharmacy and medication interaction risk. Narrative clinical review using targeted literature searches and guideline synthesis. Contemporary clinical guidelines, systematic reviews, meta-analyses, randomised controlled trials and other clinically applicable evidence addressing the diagnosis and management of headache disorders in adults were prioritised. Evidence relevant to primary care, comorbidity-aligned treatment selection, non-pharmacologic interventions, medication-overuse headache and office-based procedures was emphasised. PubMed/MEDLINE and major headache guideline sources were searched through 7 August 2026. Reference lists of selected publications were also reviewed to identify additional clinically relevant evidence. Most headache disorders can be managed in primary care using a structured approach that confirms the headache phenotype, screens for secondary causes, identifies comorbidities and aligns treatment with the patient's broader clinical needs. Selecting therapies that benefit both headache and coexisting conditions may reduce medication burden and improve adherence and tolerability. Non-pharmacologic interventions and structured follow-up are important components of care. Recognition and management of medication overuse can improve outcomes, while selected office-based procedures may provide additional options when used with appropriate attention to evidence limitations, patient selection and clinician competence. Comorbidity-aligned headache care offers primary care clinicians a practical framework for individualising treatment, limiting unnecessary medication layering and integrating pharmacologic and non-pharmacologic strategies. This approach may improve headache outcomes while supporting management of the patient's overall health. This narrative review was not prospectively registered.