• No single feature required or sufficient to make diagnosis
• > 5 attacks lasting 4 to 72 hrs
• > 2 of the following:

1. unilateral
2. pulsating
3. moderate to severe intensity
4. pain worsened by exertion

• At least one of the following: nausea or vomiting, photophobia and phonophobia
• No organic disease that might cause headaches

• At least 10 episodes occurring on < 1 day per month on average (< 12 days per year)
• Headache lasting from 30 min to 7 days
• Headache has at least two of the following characteristics:

1. Bilateral location pressing/tightening (non-pulsating) quality
2. Mild or moderate intensity not aggravated by routine physical activity such as walking or climbing

• Both of the following:

1. No nausea or vomiting (anorexia may occur)
2. Either photophobia or phonophobia

• Frontal headache accompanied by pain in one or more regions of the face, ears, or teeth
• Clinical, nasal endoscopic, CT and/or MRI imaging and/or laboratory evidence of acute or acute-on-chronic rhinosinusitis
• Headache and facial pain develops simultaneously with onset or acute exacerbation of rhinosinusitis
• Headache and/or facial pain resolve within 7 days adter remission or successful treatment of acute or acute-on-chronic rhinosinusitis

• Headache present on > 15 days/month
• Regulat overuse for > 3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache
• Headache has developed or markedly worsened during medication overuse
• Headache resolves or reverts to its previous pattern within 2 months after discontinuation of overused medication

• At least 5 attacks
• Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 min if untreated
• Headache is accompanied by at least one of the following:

1. ipsilateral conjunctival  injection and/or lacrimation
2. ipsilateral nasal congestion and/or rhinorrhea
3. ipsilateral eyelid edema
4. ipsilateral forehead and facial sweating
5. ipsilateral miosis and/or ptosis
6. a sense of restlessness or agitation

• Attacks have a frequency from one every other day to 8 per day
• Not attributed to another disorder

• At least 20 attacks

1. attacks of unilateral orbital, supraorbital or temporal stabbing or pulsating pain lasting 5-240 sec
2. pain is accompanied by ipsilateral conjunctival injection and lacrimation
3. attacks occur with a frequency from 3 to 200 per day

• Attacks, in a menstruating woman, fulfilling criteria for migraine without aura
• Attacks occur exclusively on day 1 + 2 of menstruation in at least two out of three menstrual cycles and at no other times of the cycle

• cluster-type headache
• abnormal finding on neurologic examination
• undefined headache
• headache with aura
• headache aggravated by exertion or a valsalva-like maneuver
• headache with monitoring

Abortive

• NSAIDs
• APAP/Caffeine/Aspirin
• Metoclopramide or prochlorperazine

Abortive

• Triptans -- specific abortives
• Ergotamine derivatives

• Chest tightness
• Chest pressure
• Chest pain
• Probably not cardiac in origin
• Probably due to vasoconstriction or esophageal spasm
• Fatigue Paresthesias Nausea
• Dizziness
• Drowsiness

Ischemic heart disease is a CI to these drugs

Naratriptan

Almotriptan

• Cardiovascular -- CI in CAD and in those at risk for CAD
• Serotonin syndrome w/ SSRI

• Represents a re-organization of the CNS neuronal circuitry
• Presence of cutaneous allodynia predicts triptan failure and refractory headache
• Presence of cutaneous allodyina predicts risk of transformation

• Anticonvulsants (valproate/divalproex, gabapentin, topirmate)
• Antidepressants (TCAs, SSRIs)
• Beta-Blockers (propranolol, nadolol, atenolol, timolol)
• Calcium channel blockers (verapamil, nimodipine)
• Serotonin Antagonists (methysergide)
• Others (NSAIDs, neuroleptics)
• Dietary supplements (butterbur, feverfew)