From the Guidelines
For tension headaches, I strongly recommend starting with over-the-counter pain relievers like ibuprofen (400mg) or acetaminophen (1000mg) as the first line of treatment, as evidenced by the 2023 VA/DoD guideline 1. This approach is supported by the guideline's "weak for" recommendation for ibuprofen and acetaminophen for the treatment of acute tension-type headache.
- The goals of treating tension headaches include rapid alleviation of pain and restoration of function, with critical outcomes considered being time to pain freedom and headache intensity 2 hours after treatment.
- In addition to medication, lifestyle modifications such as maintaining good posture, taking regular breaks to stretch, and staying hydrated can help manage tension headaches.
- Stress management techniques like deep breathing exercises and progressive muscle relaxation can also be beneficial in reducing headache frequency and severity.
- If headaches persist, preventive options like amitriptyline (50-100mg nightly) may be considered, as it has been found to significantly reduce monthly headache days 1.
- Regular physical activity, such as aerobic exercise or progressive strength training, can also be beneficial in managing tension headaches and migraines, with a "weak for" recommendation for its use in prevention 1.
From the Research
Tension Headache Plan
- Tension-type headaches account for 90% of all headaches diagnosed by healthcare professionals and are associated with young age, poor health, sleep disturbances, anxiety, stress, and poor posture 2
- Diagnosis and treatment of tension headaches often involve determining the underlying cause, but commonly include over-the-counter pain medication, with adjunctive and alternative treatment modalities also being considered 2
- Osteopathic manipulative treatment and lifestyle modifications have been shown to be effective in resolving tension headaches that are initially non-responsive to pain medication 2
Treatment Options
- Tricyclic antidepressant medication and stress management therapy have been found to be modestly effective in treating chronic tension-type headaches, with combined therapy producing more significant reductions in headache activity and disability 3
- Amitriptyline, a tricyclic antidepressant, has been recommended for the treatment of chronic tension-type headache, with a level A recommendation based on the analysis of 10 studies 4
- Acute treatments for tension-type headaches include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), which have been shown to be more effective than placebo in reducing headache symptoms 5
- Preventive treatments, such as antidepressants and antiepileptics, may also be considered for the management of chronic tension-type headaches, although the evidence for their effectiveness is limited 6, 5
Lifestyle Modifications
- Lifestyle modifications, such as relaxation techniques and cognitive behavioral therapy, may be beneficial in reducing stress and anxiety, which are common triggers for tension-type headaches 3, 5
- Physical therapy interventions, such as spinal manipulations and exercise, may also be considered as part of a comprehensive treatment plan for tension-type headaches, although the evidence for their effectiveness is inconsistent 5