Page 38 Acute Pain Management
P. 38






Acute
headache

Tension‐type
headache

1.
 Acupuncture
is
effective
in
the
treatment
of
tension‐type
heachache
(N)
(Level
I

[Cochrane
Review]).

2.
 The
addition
of
caffeine
to
aspirin
or
paracetamol
improves
analgesia
in
the
treatment
of

episodic
tension‐type
heachache
(U)
(Level
I).

3.
 Simple
analgesics
such
as
aspirin,
paracetamol
or
NSAIDs,
either
alone
or
in
combination,

are
effective
in
the
treatment
of
episodic
tension‐type
heachache
(U)
(Level
II).

SUMMARY
 4.
 Triptans
are
effective
in
the
treatment
of
severe
migraine
(U)
(Level
I).

Migraine




Aspirin‐metoclopramide
is
effective
in
the
treatment
of
mild‐to‐moderate
migraine
(U)

5.

Parenteral
metoclopramide
is
effective
in
the
treatment
of
migraine
(U)
(Level
I).

6.
 (Level
I).

7.
 Over‐the‐counter
medications,
including
combined
paracetamol‐aspirin‐caffeine

preparations,
are
effective
in
the
treatment
of
migraine
with
mild‐to‐moderate

symptoms
and
disability
(N)
(Level
I).


8.
 Effervescent
aspirin,
ibuprofen
or
dipyrone
are
effective
in
the
treatment
of
migraine
(N)

(Level
I).

9.
 In
children
or
adolescents
with
migraine,
ibuprofen
or
intranasal
sumatriptan
(over

12
years
of
age)
are
effective
treatments
(N)
(Level
I).

10.
 Pethidine
is
less
effective
than
most
other
migraine
treatments
and
should
not
be
used

(N)
(Level
I).

11.
 Parenteral
prochlorperazine,
chlorpromazine
or
droperidol
are
effective
in
the
treatment

of
migraine,
especially
in
the
emergency
department
(N)
(Level
II).

12.
 Paracetamol
is
effective
in
the
treatment
of
mild‐to‐moderate
migraine
(U)
(Level
II).


13.
 A
‘stratified
care
strategy’
is
effective
in
treating
migraine
(U)
(Level
II).

Cluster
headache

14.
 Parenteral
triptans
(sumatriptan
or
zolmitriptan)
(S)
or
oxygen
therapy
(U),
are
effective

treatments
for
cluster
headache
attacks
(Level
II).


Postdural
puncture
headache

15.
 There
is
no
evidence
that
bed
rest
is
beneficial
in
the
treatment
and
prevention
of

postdural
puncture
headache
(U)
(Level
I
[Cochrane
Review]).

16.
 The
incidence
of
postdural
puncture
headache
is
reduced
by
using
small‐gauge
spinal

needles
and/or
a
non‐cutting
bevel
(U)
(Level
I).
 

17.
 Further
high
quality
trials
are
required
to
determine
the
efficacy
of
epidural
blood
patch

administration
in
the
treatment
of
postdural
puncture
headache
(U)
(Level
I),
however

benefit
is
likely
(N)
(Level
II).


 Opioids
should
be
used
with
extreme
caution
in
the
treatment
of
headache
(U).

 Frequent
use
of
analgesics,
triptans
and
ergot
derivatives
in
the
treatment
of
recurrent

acute
headache
may
lead
to
medication
overuse
headache
(U).


xxxviii
 Acute
Pain
Management:
Scientific
Evidence

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