Differential Diagnoses and Medication-Induced Headache Assessment

Primary Differential Diagnoses

The American Academy of Neurology suggests that patient meets criteria for chronic migraine: ≥15 headache days per month for >3 months, with migraine features on ≥8 days per month 2
Unilateral location, severe intensity requiring bed rest, and temporal/occipital spread are classic migraine characteristics, according to the International Headache Society 1, 2
Previous response to Maxalt (triptan) strongly supports migraine diagnosis, as stated by the American Headache Society 2

The Mayo Clinic recommends that stimulant medications like Vyvanse (50 mg daily) can cause headaches as a common adverse effect 6
The American Academy of Neurology notes that bupropion XL (300 mg + 150 mg AM) can exacerbate migraine frequency due to its stimulant properties 5

The American Family Physician suggests restarting Maxalt for acute migraine attacks as previously effective 2, 7
The American Academy of Neurology recommends limiting acute medication use to <10 days per month to prevent MOH 3
The American Headache Society advises avoiding opioids or butalbital-containing medications 8

The Nature Reviews Neurology journal suggests reducing or discontinuing armodafinil, as it has the highest likelihood of contributing to headaches given dose and frequency 1
The Mayo Clinic Proceedings journal notes that topiramate has the strongest evidence for chronic migraine prevention, and can be considered if duloxetine is ineffective 5, 6