What are the treatment options for tension headache pain relief?

From the Guidelines

For tension headache pain relief, I strongly recommend starting with over-the-counter medications like ibuprofen (400 mg) or acetaminophen (1000 mg) as needed, not exceeding maximum daily doses, as these demonstrate statistically significant improvement in pain-free response at 2 hours 1.

Key Recommendations

• Apply a cold or warm compress to your forehead or neck for 10-15 minutes to help relax tense muscles and improve blood flow.
• Practice relaxation techniques such as deep breathing, gentle neck stretches, or progressive muscle relaxation to reduce stress and promote relaxation.
• Stay hydrated by drinking 8-10 glasses of water daily and maintain regular sleep patterns to help prevent headaches.
• For immediate relief, massage your temples, neck, and shoulders in circular motions for 5-10 minutes to relax tense muscles and improve blood flow.
• Consider aerobic exercise or physical therapy as a preventive measure for tension headaches, as these have been shown to be beneficial in reducing headache frequency and intensity 1.

Important Considerations

• If headaches persist more than 2-3 days, occur more than 15 days per month, or are accompanied by severe symptoms like fever or vision changes, consult a healthcare provider as prescription medications or preventive treatments may be necessary.
• Amitriptyline at 50 mg and 100 mg is recommended for preventive treatment of chronic tension headaches, but be aware of potential anticholinergic adverse effects, especially among older patients and those with multiple cardiac comorbid conditions 1.
• OnabotulinumtoxinA is not recommended for the prevention of chronic tension headaches, as it did not show statistically significant improvement in critical outcomes 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 typically causes pain that radiates in a band-like fashion bilaterally from the forehead to the occiput, and is described as tightness, pressure, or dull ache 2.
• Treatment of tension-type headache typically involves the use of over-the-counter analgesics, such as NSAIDs and acetaminophen, which have been shown to be effective for short-term pain relief 3.
• The use of pain relievers more than twice weekly places patients at risk for progression to chronic daily headache 2.
• Sedating antihistamines or antiemetics can potentiate the pain-relieving effects of standard analgesics, and analgesics combined with butalbital or opiates are often useful for tension-type pain but have an increased risk of causing chronic daily headache 2.
• Amitriptyline is the most widely researched prophylactic agent for frequent headaches, and is recommended as a preventive treatment for individuals with frequent episodic and chronic TTH 2, 4.

Pharmacological Therapy

• Simple analgesics, such as NSAIDs and acetaminophen, have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of TTH 3, 4.
• Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and if simple analgesics are ineffective, poorly tolerated or contraindicated 4.
• Recommended preventive treatments include amitriptyline, venlafaxine and mirtazapine 4.

Non-Pharmacological Therapies

• There is limited evidence concerning the effectiveness of non-pharmacological therapies, such as biofeedback, relaxation training, self-hypnosis, and cognitive therapy, for the treatment of TTH 2, 3.
• Some studies have found inconsistent results for the effectiveness of relaxation therapy, EMG biofeedback, and cognitive behavioural treatment in patients with TTH 3.