-Not all headaches are migraines!
-Always important to consider red flag features as they may suggest a secondary headache syndrome
-Remember to consider new daily persistent headache (NDPH) or trigeminal autonomic cephalgias in a patient with constant daily headache, especially if constant from onset
-NDPH may have some migrainous features, but tends not to
-TAC’s like hemicrania continua often have autonomic features (unilateral ptosis, lacrimation, conjunctival injection, congestion, rhinorrhea, sweating/flushing)
-Consider an indomethacin trial if you have a suspicion for TAC:
-- Indomethacin 25mg TID x 5 days, if no improvement, increase to 50mg TID x 5 days. If no relief at all, stop.
-- If relief, plan to stay at that dose for at least 4-6 weeks, then plan to taper off slowly (can add gabapentin to help aid in taper)
-- If cannot tolerate indomethacin or there is a contraindication, consider trial of gabapentin, melatonin 9-10mg qhs, topiramate