4 small RCT – 3 showing reduced headaches frequency over 1-4 weeks
Greater Occipital Nerve Block
155 IU
195 IU
SC every 12 weeks
Serotonin antagonist
Drug
Starting dose
Increment
Maximum dose
Pizotifen
0.5 mg
0.5-1 mg
4.5 mg/day (divided into 3 doses)
Supplements
Drug
Starting dose
Increment
Maximum dose
Co-enzyme Q10
150 mg/day
Magnesium
400 mg/day
200 mg
600 mg/day
Riboflavin
400 mg/day
Tricyclic antidepressants
Drug
Starting dose
Increment
Maximum dose
Amitriptyline
10 – 25 mg
10 – 25 mg/day
150 mg ON
Safety alert *: In girls and women of childbearing potential, valproate should be initiated and supervised by a specialist and only prescribed when other medications have not been tolerated or have found to be ineffective. This is because of 30-40% risk of neurodevelopmental disability in unborn babies exposed to valproate (MHRA April 2017). Valproate should only be prescribed by following the MHRA guidance, including a signed contraceptive plan and signed consent form documenting discussion of the risks (see MHRA website).
(Tables taken from the British Association for the Study of Headache’s National Headache Management System for Adults 2019)