Red flags requiring imaging: thunderclap onset, worst headache of life, focal neurological deficit, age > 50 new onset
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Triptan (sumatriptan) is first-line abortive — contraindicated in uncontrolled HTN, CAD, prior stroke
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Preventive therapy if ≥ 4 headache days/month: propranolol, topiramate, or amitriptyline
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Must screen for medication overuse headache: analgesics > 15 days/month
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