Primary Thunderclap Headache

Treatment of this headache type is generally based on treating the underlying cause of the headache. This headache does not typically have a recurrent pattern, so abortive and preventive therapies are usually not necessary. However, if a recurrent benign pattern of primary thunderclap headache does occur after evaluations with a physician have been completed, the following medications are sometimes used.

1. Abortive: What to take “as needed” for a headache. The earlier the medicine is taken, the more effective it will be. These are the medications used most commonly, although this is not an all-inclusive list.
   1. Nonsteroidal anti-inflammatory drugs (NSAIDs)/Analgesics: (Until this headache is evaluated urgently and cleared with normal testing with a physician, Acetaminophen would be the only safe one.)
      ---Indomethacin (Indocin) (This tends to be the most effective one.)
      ---Diclofenac (Cataflam)
      ---Naproxen (Aleve)
      ---Ibuprofen (Advil, Motrin)
      ---Acetaminophen Extra Strength (Tylenol)
      ---Excedrin (Tylenol +/- Aspirin +/- Caffeine)
2. Preventive: What to take on a daily basis to try to lessen the frequency and/or intensity of the headaches. Preventive medicines generally take 4-6 weeks to start working and 2-3 months for full effect, assuming the correct dose of the medication is reached. These are the medications used most commonly and tend to have the most benefits, although this is not an all-inclusive list. However, this type of headache usually is not treated with a daily preventive medicine because if it is a recurrent pattern, it is usually an infrequent one.
   1. Anti-hypertensive (blood pressure) medications:
      ---Propranolol (Inderal)
      ---Metoprolol (Toprol)
      ---Atenolol (Tenormin)
      ---Nadolol (Corgard)
      ---Lisinopril (Zestril)
      ---Candesartan (Atacand)
      ---Verapamil (Calan)
      ---Acetazolamide (Diamox)
   2. Anti-convulsant (Anti-seizure) medications:
      ---Topiramate (Topamax)
      ---Gabapentin (Neurontin)
      ---Divalproex sodium (Depakote)
      ---Zonisamide (Zonegran)
   3. Anti-depressant/Anti-anxiety medications:
      ---Amitriptyline (Elavil)
      ---Nortriptyline (Pamelor)
      ---Venlafaxine XR (Effexor XR)
      ---Desvenlafaxine (Pristiq)
      ---Duloxetine (Cymbalta)