From the Guidelines
For tension-like headaches where NSAIDs or Tylenol are not options, I strongly recommend considering CGRP antagonists-gepants (rimegepant, ubrogepant, or zavegepant) as a viable alternative. According to the latest clinical guideline from the American College of Physicians 1, these options have shown efficacy in treating moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen.
Key Considerations
- The choice of a specific treatment should be based on individualized decision making, taking into consideration patient preferences and factors such as route of administration and cost 1.
- It's also important to counsel patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy to improve efficacy 1.
- For patients who do not tolerate or have inadequate response to all other pharmacologic treatments, the ditan lasmiditan may be considered as an alternative 1.
Additional Recommendations
- Consider using a nonoral triptan and an antiemetic in people having severe nausea or vomiting 1.
- Patients should be aware of medication overuse and its potential to lead to medication-overuse headache 1.
- Regular stress management through meditation, yoga, or deep breathing exercises can also help prevent tension headaches by reducing muscle tension.
- Ensure patients are drinking enough water and improve their sleep habits to prevent dehydration and sleep-related headaches.
From the FDA Drug Label
In three of these studies there was a significantly greater improvement with cyclobenzaprine than with diazepam, while in the other studies the improvement following both treatments was comparable The efficacy of cyclobenzaprine hydrochloride tablets 5 mg was demonstrated in two seven-day, double-blind, controlled clinical trials enrolling 1405 patients. The treatment for tension-like headaches without using NSAIDs or Tylenol is cyclobenzaprine.
- Cyclobenzaprine has been shown to be effective in treating muscle spasms and may be used for tension-like headaches.
- The recommended dose is 5 mg, which has been demonstrated to be effective in clinical trials 2.
- Amitriptyline may also be considered, but its primary use is as an antidepressant, and it may have a slower onset of action for headache relief 3.
From the Research
Treatment Options for Tension-Type Headache
- Non-pharmacological treatments, such as physical therapy and relaxation techniques, can help control tension-type headache 4
- A study found that physical therapy based on cervical spine kinesiotherapy and posture correction exercises, combined with relaxation techniques, significantly decreased the frequency and intensity of tension-type headache 4
- Complementary and alternative approaches, including psychological therapies, acupuncture, and physical treatments, can be used in combination with medications to increase the success of treatment 5
- EMG biofeedback, cognitive behavioral therapy, and relaxation training may be beneficial for patients with tension-type headache 5
Effectiveness of Physical Therapy
- A systematic review found that physical therapy interventions, such as spinal manipulations, exercise, and physical applications, showed inconsistent results in reducing tension-type headache 6
- However, another systematic review found that physical therapy approaches that address the cranio-cervical-mandibular region can significantly decrease the intensity of pain and frequency of headache episodes in the short and medium term 7
- More long-term longitudinal studies are needed to determine the effectiveness of physical therapy in managing tension-type headache 7
Pharmacological Treatment
- NSAIDs and acetaminophen are effective for short-term pain relief in patients with tension-type headache 6
- However, the use of NSAIDs and acetaminophen may not be suitable for all patients, and alternative treatments may be necessary 8
- Other pharmacological treatments, such as triptans and gepants, are available for acute migraine treatment, but may not be effective for tension-type headache 8