From the Research
The most effective treatment for a refractory tension headache is a multi-modal approach, including pharmacological and non-pharmacological interventions, with a focus on preventive medications such as amitriptyline or venlafaxine, as recommended by the most recent study 1. The treatment of refractory tension headaches requires a comprehensive approach, taking into account the patient's medical history, lifestyle, and preferences.
- First-line options include simple analgesics, such as NSAIDs (e.g., ibuprofen or naproxen) or acetaminophen, which have evidence-based effectiveness for the acute treatment of tension-type headaches 1.
- If these are ineffective, adding a muscle relaxant like cyclobenzaprine or tizanidine can help, especially if muscle tension is prominent.
- For persistent cases, preventive medications such as amitriptyline (starting at 10mg nightly, gradually increasing to 25-50mg) or venlafaxine may be necessary, as they have been shown to be effective in reducing the frequency and severity of tension-type headaches 1.
- Non-pharmacological approaches are equally important and include stress management techniques, regular physical activity, proper hydration, consistent sleep patterns, and physical therapy.
- Trigger point injections, acupuncture, or nerve blocks might be considered for highly refractory cases. These treatments work by addressing the underlying mechanisms of tension headaches, including muscle contraction, central sensitization, and neurogenic inflammation.
- Patients should maintain a headache diary to identify triggers and evaluate treatment effectiveness, as recommended by various studies, including 2.