From the Guidelines
For tension headache pain relief, I strongly recommend starting with ibuprofen (400 mg) or acetaminophen (1000 mg) as needed, as these demonstrate statistically significant improvement in pain-free response at 2 hours 1.
Key Recommendations
- Ibuprofen (400 mg) or acetaminophen (1000 mg) can be used for the treatment of acute tension-type headache (TTH) 1.
- Amitriptyline at 50 mg and 100 mg is recommended for preventive treatment of chronic TTH, as both doses significantly reduce monthly headache days 1.
- Aerobic exercise or physical therapy (PT) can be used in the management of TTH, as they are beneficial in reducing headache frequency and intensity 1.
Additional Considerations
- Apply a cold or warm compress to your forehead or neck for 10-15 minutes to help relax tense muscles.
- Practice relaxation techniques such as deep breathing, gentle neck stretches, or progressive muscle relaxation to decrease stress hormones that contribute to tension headaches.
- Stay hydrated by drinking 8-10 glasses of water daily and maintain regular sleep patterns, aiming for 7-8 hours nightly.
- Identify and avoid personal triggers like stress, poor posture, or certain foods to prevent headaches.
- Regular physical activity for 30 minutes most days can help reduce headache frequency.
- If headaches persist despite these measures, are severe, or occur more than 15 days per month, consult a healthcare provider.
Evidence-Based Approach
The 2023 VA/DoD headache guidelines provide a broad scope of recommendations for the management of headache, including TTH 1. The guidelines suggest that ibuprofen (400 mg) or acetaminophen (1000 mg) can be used for the treatment of acute TTH, and amitriptyline at 50 mg and 100 mg is recommended for preventive treatment of chronic TTH 1. Additionally, aerobic exercise or PT can be used in the management of TTH, as they are beneficial in reducing headache frequency and intensity 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Tension Headache Pain Relief
- Tension-type headache (TTH) is a common neurological disorder characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity 2.
- The mainstay of clinical management for TTH is pharmacological therapy, which can be divided into acute and preventive treatments 2.
- Simple analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of TTH 3, 4, 2.
- Studies have shown that NSAIDs and acetaminophen are more effective than placebo in providing short-term pain relief for TTH, with no significant differences found between different types of NSAIDs, but ibuprofen showing fewer short-term side effects 4.
- The balance of benefit and harm needs to be considered when using high-dose NSAIDs for tension headache, as they may have more adverse events 3.
- Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and may include amitriptyline, venlafaxine, and mirtazapine, as well as some selected non-pharmacological therapies 2.
Treatment Options
- Acute treatment options for TTH include:
- NSAIDs
- Acetaminophen
- Combination products that include caffeine
- Preventive treatment options for TTH include:
- Amitriptyline
- Venlafaxine
- Mirtazapine
- Non-pharmacological therapies
Considerations
- The diagnosis of TTH is based on headache history and the exclusion of alternative diagnoses, with clinical criteria provided by the International Classification of Headache Disorders, third edition 2.
- Patients presenting with headache should be evaluated to determine whether their headache is most likely a primary or a secondary headache disorder, and to identify any symptoms or signs that suggest an urgent medical problem 5.