›Supportive measures
›Environment modification
›Quiet area
›Low light if photophobia present
›Hydration
›Oral fluids if tolerated
›IV crystalloids if dehydration suspected
›Musculoskeletal interventions
›Heat or cold packs to neck or shoulders
›Gentle stretching guidance
›Trigger management
›Sleep optimization plan
›Ergonomic adjustments
›Oral options
›Acetaminophen
›1000 mg PO once
›Maximum 4000 mg per 24 hours
›Lower maximum with liver disease or heavy alcohol use
›Ibuprofen
›400 to 600 mg PO once
›Maximum 2400 mg per 24 hours
›Avoid with significant renal disease or active GI bleed
›Naproxen
›500 mg PO once
›Maximum 1000 mg per 24 hours
›Avoid with significant renal disease or active GI bleed
›Parenteral options
›Ketorolac
›15 mg IV once
›30 mg IV once
›Avoid with significant renal disease or active GI bleed
›Acetaminophen IV
›1000 mg IV over 15 minutes once
›Consider when unable to tolerate PO
›Same daily maximum as PO
Adjuncts for muscle component
›Skeletal muscle relaxants
›Cyclobenzaprine
›5 mg PO once
›10 mg PO once
›Sedation risk
›Methocarbamol
›500 mg PO once
›750 mg PO once
›Sedation risk
›Antiemetics when nausea present
›Metoclopramide
›10 mg IV once
›Akathisia risk
›Consider diphenhydramine for akathisia
›Prochlorperazine
›10 mg IV once
›Akathisia risk
›QT prolongation risk
Avoided or limited therapies
›Opioid avoidance
›Poor efficacy for primary headache
›Recurrence risk
›Medication overuse headache risk
›Use only when alternative diagnosis requires opioid or contraindications limit options
›Clear documentation of rationale
›Lowest effective dose
›Butalbital combinations avoidance
›Medication overuse headache risk
›Dependence risk
›Rebound headache risk
›Avoid as first-line therapy
›Use only with specialist plan
›If inadequate response after first-line
›Reconsider phenotype
›Migraine features emerging
›Secondary headache features emerging
›Additional NSAID strategy
›Avoid stacking multiple NSAIDs
›Switch route if vomiting
›Occipital nerve block consideration
›Occipital tenderness pattern
›Clinician skill dependent
›Practice recommendations overview
›Primary tension-type acute treatment
›NSAIDs and acetaminophen as first-line
›Avoid routine opioids
›Imaging strategy
›No routine neuroimaging without red flags
›Use structured red flag assessment