Headache
Adults with migraine. No dose: the Canadian sources here print none.
Investigate
- CWC Choosing Wisely Canada
Treat
- CWC Choosing Wisely Canada
- CHS Canadian Headache Society
| Decision | Guideline |
|---|---|
| Acute migraine | NSAIDs or a triptan first.No opioid or opioid/barbiturate combination first-line. CWC, CHS opens in a new tabChoisir avec soin (French) opens in a new tab |
| Frequent attacks | Headache diary first.Overuse risk: opioids, triptans, ergots or combinations 10 or more days a month; NSAIDs or acetaminophen 15 or more. CWC, CHS opens in a new tabChoisir avec soin (French) opens in a new tab |
| Lifestyle | Regular meals and sleep, trigger and stress management.Relaxation training, pacing, how to take acute drugs. CWC, CHS opens in a new tabChoisir avec soin (French) opens in a new tab |
| Prevention, strong | Most CGRP-blocking drugs (episodic and chronic).Propranolol (episodic and chronic). OnabotulinumtoxinA (chronic). Candesartan, Metoprolol, Amitriptyline, Nadolol, Riboflavin, Coenzyme Q10, Magnesium citrate, Butterbur (episodic). |
| Prevention, weak | Episodic:Topiramate, Memantine, Levetiracetam, Enalapril, Melatonin, Divalproex, Flunarizine, Pizotifen, Venlafaxine, Verapamil, Lisinopril. Topiramate (chronic). Against Gabapentin, Statins (alone or add-on). Rimegepant weak; not approved in Canada as prevention. |
| Do not use | Episodic:OnabotulinumtoxinA, Feverfew, Ginger. |
Reviewed 18 October 2026 against the official sources below.
Sources
Red round: Canada. The code names the body; each section's key gives its full name.