• Over-the-counter pain relievers such as ibuprofen (in Advil, for example) or acetaminophen (Tylenol) can often treat tension headaches.
• Antidepressants can reduce headache frequency and severity by changing the level of brain chemicals such as serotonin.

Small adhesive sensors are attached to muscles to help you become more aware and better able to control your response to stress.

Therapy such as cognitive behavioral therapy can lessen headaches by helping you lower stress, anxiety and negative thoughts. You can break a cycle in which headaches cause negative thoughts and inactivity, which in turn lead to more headaches.

Acupuncture: Acupuncture places thin needles in the body along lines of energy. Studies show acupuncture can lessen the number of tension headaches in the short term compared with routine care.

Relaxation: Apps, websites and classes can guide you in meditation and mindfulness exercises. Here are a few places to start. Find more on our Headache FAQ and resources page.

• OHSU mindfulness classes
• Headspace app
• Calm app
• Palouse Mindfulness

• An over-the-counter medication with ibuprofen (Advil, for example) or a combination of acetaminophen, aspirin and caffeine (such as in some Excedrin products) can relieve pain.
• A shot or nasal spray containing triptan can shrink blood vessels and reduce pressure.
• A medication called dihydroergotamine (DHE) can be given in an IV, shot or nasal spray. At OHSU, patients with a migraine can receive quick outpatient IV treatment with DHE.

The U.S. Food and Drug Administration approved three new medications in 2018 to help prevent migraines.

• Aimovig
• Emgality
• Ajovy

All three block a substance called calcitonin gene-related peptides, or CGRP. They have fewer side effects than other migraine medications. Patients use a self-injection about once a month, depending on the medication.

• Topiramate, an anti-seizure pill, can lower how often you get migraines.
• Beta-blockers such as propranolol and metoprolol, usually taken in pill form, relax blood vessels to improve blood flow. This helps prevent migraines for many patients.
• Antidepressants such as amitriptyline and venlafaxine can reduce headache frequency and severity by altering brain chemicals such as serotonin. They can also treat depression and anxiety, which often go hand in hand with migraines.

Trigger point injection: This therapy uses an image-guided injection of anesthetic into a muscle knot. The anesthetic calms the muscle to help prevent headaches.

Botox: Therapeutic injections of Botox in the head, neck and shoulders can reduce the number of migraines for up to three months.

Occipital nerve block: This injection of medication into the scalp at the back of your head can prevent migraines.

Sphenopalatine ganglion block: An anesthetic is given to block nerves behind the nose from sending pain signals to the brain. Usually, patients come to our clinic to have this medication applied through nasal passages.

Vagus nerve stimulation: A handheld device sends mild electrical stimulation to the vagus nerve through the skin on your neck.

Trigeminal nerve stimulation: A stimulator is attached to the forehead with adhesive for 20 minutes a day to prevent migraines. The FDA approved the device for migraines in 2014. It stimulates the trigeminal nerve, which has branches that end at the forehead.

Acupuncture: Acupuncture places thin needles in the body along lines of energy. Studies indicate that acupuncture can reduce the number of headaches with fewer side effects than some migraine medications. Longer-term studies are needed.

Supplements: Vitamins and minerals such as riboflavin and magnesium can help prevent migraines. See our Headache FAQ and Resources page for recommended daily doses.

• Verapamil, a medication called a calcium channel blocker, comes in a tablet and lowers blood pressure.
• Topiramate, an antiseizure pill, can help prevent cluster headaches as well as migraines.
• Lithium, a mineral, is taken in pill form to prevent cluster headaches.

Trigger point injection: An image-guided injection of anesthetic into a muscle knot calms the muscle to help prevent headaches.

Nerve therapies:

• Occipital nerve block: An injection of medication into the scalp at the back of your head can help hold cluster headaches at bay.
• Sphenopalatine ganglion block: An anesthetic keeps nerves behind the nose from sending pain signals to the brain. Usually, patients come to our clinic to have this medication applied through nasal passages.
• Vagus nerve stimulation: A handheld device sends mild electrical stimulation to the vagus nerve through the skin on your neck. This therapy can lower the number of headaches.

Acupuncture places thin needles in the body along lines of energy. Studies indicate that acupuncture can bring greater pain relief with fewer side effects than medications can. Longer-term studies are needed to verify results, though.