Event 4: Evaluation Treatment Response

Follow Up Visit 1: Part 1

Test Your Knowledge

Joe notes that Sumatriptan isn’t always helpful for his headaches. He also thinks it makes him tired. His friend takes hydrocodone for his headaches and Joe wonders if this might work for him.

True or false: Is hydrocodone an appropriate alternative medication?


Follow Up Visit 1: Part 2

Headache Spectrum

Headaches evolve along a spectrum with migraine as most severe.

Chart showing migraine evolution
Migraine evolution

Follow Up Visit 2


Stress is the most commonly reported trigger of headache attacks.

Stress management for headache treatment
Stress management

Multiple Categories of Migraine Triggers

Dietary Items

  • aged cheeses (tyramine)
  • alcohol (tyramine & sulfates; dehydration)
  • caffeine withdrawal
  • artificial sweeteners (aspartame)
  • processed meats (nitrates, MSG)


  • oversleeping
  • napping
  • too little sleep

Bright Light, Odors

  • perfume
  • smog
  • cigarettes 
  • flashing lights or screens


  • menarche
  • menstruation
  • menopause
  • birth control pills
  • pregnancy


  • exercising too much
  • exercising in heat

Stress Let Down

  • vacation
  • weekend

Self-Care Techniques

Self-care techniques are effective in reducing stress.

  • Take a break
  • Exercise
  • Smile and laugh
  • Get social support
  • Meditate

Source: American Psychological Association

Mental Health Evaluation

A mental health evaluation may be needed if stress is excessive.

  • Excessive stress
  • Depression and anxiety
  • Worsening headaches

When to Consider a Mental Health Evaluation

Consider a mental health evaluation if any of the following are experienced more days than not:

  • Feeling little interest or pleasure in doing things
  • Feeling down, depressed, or hopeless
  • Feeling nervous, anxious, or on edge
  • Not being able to stop or control worrying

Source: Kroenke et al. Psychosomatics 2009;50:613-621.


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