As droperidol goes back on shortage, I wanted to give a brief review of primary headache treatments. Most therapies for primary headaches have a ~60% rate of pain relief, and there is no predictable overlap between drug classes, so if one class doesn’t work, try another class of medications.

  1. Triptans:  The constellation of symptoms and their duration do not appear related to the effectiveness of these medications for any primary headache, so use them on any of them in patients who aren’t pregnant and don’t have cardiac risk factors putting them at risk from its transient vaso-spastic effects
    1. Ellitriptan (Relpax) 40 mg po, this should be your first line in the ED, multiple studies have shown it to be as effective a