What is the treatment for tension headache (HA) in a young, healthy female?

From the Guidelines

For a young, healthy female with tension headaches, I recommend starting with acetaminophen (1000 mg) or ibuprofen (400 mg) for acute treatment, as these demonstrate statistically significant improvement in pain-free response at 2 hours 1.

Key Considerations

• The goals of treating tension-type headaches include rapid and sustained alleviation of pain and restoration of function.
• Critical outcomes considered for abortive therapies include time to pain freedom and headache intensity 2 hours after treatment.
• For preventive treatment, amitriptyline at 50 mg and 100 mg is recommended because both doses were found to significantly reduce monthly headache days 1.

Non-Pharmacological Approaches

• Aerobic exercise or progressive strength training received a “weak for” recommendation for the prevention of both migraine and TTH 1.
• Rehabilitation delivered through physical therapy (PT) received a “weak for” recommendation and is beneficial in the management of migraine and TTH 1.

Pharmacological Treatment

• Acetaminophen (1000 mg) or ibuprofen (400 mg) are recommended for acute treatment of tension-type headaches 1.
• Amitriptyline at 50 mg and 100 mg is recommended for preventive treatment because both doses were found to significantly reduce monthly headache days 1.

Important Considerations

• 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 with amitriptyline 1.
• OnabotulinumtoxinA for chronic TTH did not show statistically significant improvement in critical outcomes and is not recommended 1.

From the Research

Tension-Type Headache Treatment in Young Healthy Females

• The treatment of tension-type headache (TTH) in young healthy females can involve various approaches, including pharmacological and non-pharmacological interventions 2, 3.
• Studies have shown that tricyclic antidepressant medication and stress management therapy can be effective in reducing headache activity and improving quality of life in patients with TTH 2.
• Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), has been found to be effective in providing pain relief for acute episodes of TTH, with a number needed to treat (NNT) of 14 for being pain-free at 2 hours 4.
• Other NSAIDs and acetaminophen have also been shown to be effective in providing short-term pain relief for TTH, with NSAIDs being more effective than acetaminophen in some studies 4, 5.
• Behavioral therapies, such as relaxation and cognitive-behavioral therapy, may also be beneficial in reducing headache frequency and severity, although the evidence is inconsistent 2, 5.

Pharmacological Interventions

• Tricyclic antidepressant medication, such as amitriptyline, has been found to be effective in reducing headache activity and improving quality of life in patients with TTH 2.
• Ibuprofen and other NSAIDs have been shown to be effective in providing pain relief for acute episodes of TTH 4, 5.
• Acetaminophen has also been found to be effective in providing short-term pain relief for TTH, although it may be less effective than NSAIDs in some studies 4, 5.

Non-Pharmacological Interventions

• Stress management therapy, including relaxation and cognitive-behavioral therapy, may be beneficial in reducing headache frequency and severity 2, 5.
• Behavioral therapies, such as biofeedback and physical therapy, may also be beneficial in reducing headache frequency and severity, although the evidence is inconsistent 5.