From the Guidelines
Tension headaches can be effectively treated with ibuprofen (400 mg) or acetaminophen (1000 mg) for immediate relief, as well as amitriptyline for preventive treatment. For acute tension-type headache, the goals of treatment include rapid alleviation of pain and restoration of function. 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, ibuprofen (400 mg) or acetaminophen (1000 mg) are recommended for the treatment of acute TTH, as both demonstrate statistically significant improvement in pain-free response at 2 hours.
Some key points to consider when treating tension headaches include:
- The use of over-the-counter pain relievers like ibuprofen or acetaminophen for immediate relief
- The prescription of tricyclic antidepressants like amitriptyline for preventive treatment, which has been shown to significantly reduce monthly headache days 1
- The application of a heating pad or ice pack to the head for 5-10 minutes several times daily to reduce muscle tension
- The practice of stress management techniques like deep breathing or meditation for 10-15 minutes daily to reduce stress
- The maintenance of regular sleep patterns with 7-9 hours nightly and staying hydrated with at least 8 glasses of water daily to reduce headache triggers
- The exercise of regular physical activity for 30 minutes most days, such as aerobic exercise or progressive strength training, which has been shown to be beneficial in the management of migraine and TTH 1
It is essential to note that the evidence for other treatments, such as neuromodulation, is limited, and there is insufficient evidence to recommend for or against any form of neuromodulation for the abortive or preventive treatment of migraine 1. Additionally, onabotulinumtoxinA for chronic TTH did not show statistically significant improvement in critical outcomes and is not recommended 1.
In terms of lifestyle changes, aerobic exercise or physical therapy can be used in the management of TTH and migraines, as they have been shown to reduce headache frequency and intensity 1. Clinicians should work with their patients to craft treatment plans that account for headache type or types, comorbid conditions, and values and preferences.
From the Research
Tension Headache Treatment Options
- Tension-type headaches can be treated with various methods, including medication and non-pharmacological approaches 2, 3, 4, 5, 6
- Over-the-counter pain medications, such as ibuprofen and acetaminophen, are commonly used to treat tension headaches 5, 6
- Studies have shown that ibuprofen 400 mg can provide significant pain relief for people with frequent episodic tension-type headaches 5
- Tricyclic antidepressants, such as amitriptyline, are also used as preventive treatment for tension-type headaches 3, 4
- Non-pharmacological methods, such as stress management therapy, relaxation techniques, and acupuncture, may also be effective in treating tension headaches 3, 4, 6
Medication Treatment
- Ibuprofen 400 mg has been shown to be effective in treating acute episodic tension-type headaches, with a number needed to treat (NNT) of 14 for being pain-free at 2 hours 5
- Acetaminophen and NSAIDs are also effective for short-term pain relief in patients with tension-type headaches 6
- Tricyclic antidepressants, such as amitriptyline, have been shown to be effective in preventing tension-type headaches, with a significant reduction in headache frequency and severity 4
Non-Pharmacological Treatment
- Stress management therapy, including relaxation techniques and cognitive coping, has been shown to be effective in reducing headache frequency and severity 4
- Acupuncture has also been suggested as a potential treatment for tension-type headaches, although more research is needed to confirm its effectiveness 3
- Physiotherapy interventions, such as spinal manipulations and exercise, have shown inconsistent results in treating tension-type headaches 6