From the Guidelines
For the management of stress headaches, also known as tension-type headaches, ibuprofen (400 mg) or acetaminophen (1000 mg) is recommended for abortive treatment, and amitriptyline at 50 mg or 100 mg is recommended for preventive treatment. Stress headaches can be managed with a combination of medication and lifestyle changes. For immediate relief, over-the-counter pain relievers like ibuprofen or acetaminophen can help, as they demonstrate statistically significant improvement in pain-free response at 2 hours 1. It is essential to note that acetaminophen doses lower than 1000 mg did not show statistically significant improvement.
For prevention, amitriptyline at 50 mg and 100 mg is recommended because both doses were found to significantly reduce monthly headache days 1. Clinicians should be aware of anticholinergic adverse effects, especially among older patients and those with multiple cardiac comorbid conditions, as well as the potential for overdose.
In addition to medication, lifestyle changes such as stress management techniques, regular physical activity, adequate sleep, and proper hydration can reduce headache frequency. Aerobic exercise or progressive strength training received a “weak for” recommendation for the prevention of both migraine and TTH 1. The frequency of aerobic exercise varied but was generally 2 to 3 times per week for 30 to 60 minutes. Upper-body progressive strength training was supervised, typically 3 times per week for 30 minutes.
Some key points to consider when managing stress headaches include:
- Identifying and avoiding personal triggers like certain foods, poor posture, or eye strain
- Applying a warm or cold compress to your head or neck for 10-15 minutes
- Practicing stress management techniques such as deep breathing, progressive muscle relaxation, or meditation for 10-15 minutes daily
- Getting regular physical activity for 30 minutes most days
- Getting adequate sleep (7-9 hours nightly) and proper hydration (about 8 glasses of water daily)
If headaches are severe, persistent, or accompanied by other symptoms like fever or vision changes, it is essential to consult a healthcare provider as prescription medications or other treatments may be necessary.