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The Guidelines of the U.S. Consortium on Headache include the following:

• Educate the patient to take an active role in the management of their headaches
• Customize therapy to the individual
• Use migraine-specific medications for severe headache and for patients who previously responded poorly to NSAIDs or combination analgesic medication.
• Provide patients with nausea with non-oral route antiemetic medications
• Supply the patient with butalbital (Fioricet) as a "rescue medication" to take at home for severe headache
• Limit use of medications to prevent rebound headaches

The American Academy of Family Physicians (AAFP) and the American College of Physicians (ACOP) also recommend NSAIDs to be followed by triptans if needed. DHE 45 can be used but ergots are not recommended.

Regarding the management of acute headaches, the U.S. Consortium on Headache recommends a "striated care mode" where the patient determines which medication is best for them based on the severity of the pain so that for very severe pain the patient may begin with triptans. The AAFP/ACOP advocates the "step model" where all patients begin initially with NSAIDs and, if they are not effective, then migraine-specific medications are introduced.

For more information about the Guidelines, please click on the following link: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=10993991&ordinalpos=362&itool=EntrezSystem2.PEntrez.Pubmed.PubmedResultsPanel.PubmedRVDocSum

Guidelines regarding treatment of children with migraine headache have been published by the International Headache Society. For acute treatment of migraine headache, they recommend:

• Ibuprofen (Motrin, Advil)
• Acetaminophen (Tylenol)
• Sumatriptan nasal spray can be recommended for adolescents. There is no available data regarding oral triptans for treatment in children.