If indomethacin fails to treat the headaches, what then?
If indomethacin fails to successfully treat the headaches, reconsider the diagnosis and make sure there is no underlying cause. If upon further review the diagnosis of CPH or EPH is still likely, a range of drugs may show partial to complete relief in certain groups of patients. These include verapamil, acetylsalicylic acid, ibuprofen, naproxen, or paracetamol. These agents are not nearly as effective as indomethacin and should not be used as first-line therapy.
Neuromodulatory procedures, such as greater occipital nerve blockade, blockade of sphenopalatine ganglion, and neurostimulation of the posterior hypothalamus, are reserved for patients with refractory PH.