Treating headaches. A conceptual framework

BACKGROUND: Similar medications are effective in migraine and muscle contraction headache therefore the term recurrent headache is used to cover the spectrum of classic migraine and muscle contraction headache. OBJECTIVE: The concept of a threshold to headache triggers is proposed. Treatment for chronic headaches is directed at raising the threshold or removing triggers. DISCUSSION: The most important factors that lower the threshold to headaches are hormones, mood and sleep disturbance. Therapeutic strategies for raising the threshold and treatment of the acute headache are discussed.