From the Guidelines
Tension headaches can be effectively treated with ibuprofen (400 mg) or acetaminophen (1000 mg) for acute relief, and amitriptyline (50 mg or 100 mg) for preventive treatment. According to the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1, these medications have shown statistically significant improvement in pain-free response at 2 hours for acute treatment, and significant reduction in monthly headache days for preventive treatment.
Medication Options
- Ibuprofen (400 mg) or acetaminophen (1000 mg) are recommended for acute relief of tension headaches, as they demonstrate statistically significant improvement in pain-free response at 2 hours 1.
- Amitriptyline (50 mg or 100 mg) is recommended for preventive treatment of chronic tension headaches, as it significantly reduces monthly headache days 1.
- It is essential to note that onabotulinumtoxinA is not recommended for the prevention of chronic tension headaches, as it did not show statistically significant improvement in critical outcomes 1.
Lifestyle Changes
- Applying a heating pad or ice pack to the head for 5-10 minutes several times a day can help relieve tension headaches.
- Practicing stress management techniques like deep breathing or meditation can help reduce stress, a common cause of tension headaches.
- Maintaining regular sleep patterns, staying hydrated, and exercising regularly can also help manage tension headaches.
- Addressing underlying causes such as poor posture or eye strain is crucial for long-term management of tension headaches.
Important Considerations
- If headaches are severe, persistent, or accompanied by other symptoms like fever or confusion, it is essential to seek immediate medical attention.
- Clinicians should work with patients to craft treatment plans that account for headache type, comorbid conditions, and values and preferences 1.
From the Research
Tension Headache Treatment Options
- Tension-type headache (TTH) is a common primary headache disorder that can be managed with various treatment options, including pharmacological and non-pharmacological therapies 2, 3.
- Nonprescription analgesics, such as paracetamol (acetaminophen), are indicated for the management of episodic TTH, while prophylaxis should be considered for patients with chronic TTH or those at risk of medication overuse headache 3, 4.
- Tricyclic antidepressant medication, such as amitriptyline, is recommended as a first-line drug for prophylaxis, and has been shown to be effective in reducing headache activity and disability 2, 5.
Pharmacological Therapies
- Paracetamol (acetaminophen) has been shown to be effective in providing a small benefit in terms of being pain-free at two hours for people with frequent episodic TTH who have an acute headache of moderate or severe intensity 4.
- NSAIDs, such as ibuprofen, have also been shown to be effective in providing short-term pain relief in patients with TTH, with fewer side effects compared to other NSAIDs 6.
- Amitriptyline has been shown to be effective in reducing headache activity and disability, and is recommended as a first-line drug for prophylaxis 2, 5.
Non-Pharmacological Therapies
- Cognitive-behavioral therapy has been shown to be effective in reducing headache activity and improving outcomes, and may be a useful alternative to pharmacological therapies 2, 5.
- Relaxation techniques, such as electromyography biofeedback, have also been shown to be effective in reducing headache activity, but the evidence is inconsistent and more research is needed to fully understand their effectiveness 6.
- Physical and integrative therapies, such as exercise, massage, and trigger point injection, may also be useful in managing TTH, but more research is needed to fully understand their effectiveness 3.