| Treatment Approach | Description |
|---|---|
| Analgesic Treatment | – Phenotypically guided treatment shows a 64% response rate |
| – “SKIP protocol” for severe acute pain: saline infusion, ketorolac, and anti-emetic | |
| – Avoid triptans in the first few weeks post-concussion | |
| – Occipital nerve blocks can provide long-term benefit, especially for cervicogenic or occipital neuralgia-like pain | |
| – Caution against overusing analgesics and encourage limited use for headache exacerbations | |
| – Nonpharmacological strategies (e.g., cold cloths, short rest periods) are effective in children | |
| – Facet joint injections (C2 or C3) in collaboration with radiology colleagues for suspected facet-related pain | |
| Chronic and Preventative Treatment | – Choice of prophylactic agents based on comorbidities |
| – Amitriptyline or nortriptyline for sedation or better tolerability | |
| – Propranolol if pain worsened by exercise, indomethacin if purely exercise-induced | |
| – Caution with topiramate due to cognitive complaints, but may be considered for overweight patients without depression | |
| – Flunarizine as an option for children under 10 or 11 years | |
| – Melatonin (1-10 mg) being tested in an RCT | |
| – Nutraceutical agents (magnesium, folate) may have limited efficacy | |
| – Neck physiotherapy recommended for cervicogenic component | |
| – Psychological management as an adjunct to medical therapy, including cognitive-behavioral therapy (CBT) | |
| – Biofeedback as a nonpharmacological alternative | |
| – Repetitive transcranial magnetic stimulation may be |
