From the FDA Drug Label
For outpatients, 75 mg of amitriptyline HCl a day in divided doses is usually satisfactory. In general, lower dosages are recommended for these patients Ten mg 3 times a day with 20 mg at bedtime may be satisfactory in adolescent and elderly patients who do not tolerate higher dosages. The treatment options for tension headaches include amitriptyline. The dosage of amitriptyline for adults is usually 75 mg per day in divided doses, and for adolescent and elderly patients, 10 mg three times a day with 20 mg at bedtime may be satisfactory. 1
Ibuprofen tablets are indicated for the relief of signs and symptoms of rheumatoid arthritis and osteoarthritis, for the relief of mild to moderate pain, and for the treatment of primary dysmenorrhea. The treatment options for tension headaches may also include ibuprofen, however the provided text does not explicitly state this. 2
From the Research
Tension headaches can be effectively managed with a combination of medication and non-medication approaches, with the most recent and highest quality study suggesting that paracetamol 1000 mg is effective in providing a small benefit in terms of being pain-free at 2 hours for people with frequent episodic tension-type headache who have an acute headache of moderate or severe intensity 3.
Treatment Options
- Medication approaches:
- Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) 200-400mg, acetaminophen (Tylenol) 500-1000mg, or aspirin 325-650mg can be taken every 4-6 hours as needed, not exceeding maximum daily doses.
- Preventive medications might include amitriptyline starting at 10mg daily and gradually increasing, or other tricyclic antidepressants, as shown in a randomized controlled trial that found combined therapy with tricyclic antidepressant medication and stress management therapy to be more effective than monotherapy 4.
- Non-medication treatments:
- Stress management techniques like deep breathing exercises, progressive muscle relaxation, and meditation.
- Physical approaches such as applying a heating pad or ice pack to the neck or head for 15-20 minutes, getting adequate sleep (7-9 hours nightly), staying hydrated, and regular physical activity can help prevent headaches.
Identifying and Avoiding Triggers
Identifying and avoiding personal triggers like certain foods, poor posture, or specific stressors is crucial in managing tension headaches.
Consultation with a Healthcare Provider
For headaches that persist despite these measures or occur more than 15 days per month, consultation with a healthcare provider is recommended to rule out other conditions and develop a personalized treatment plan.
Efficacy of Different Treatments
A meta-analysis of four randomized, double-blind, placebo-controlled, crossover studies found that a fixed combination of acetylsalicylic acid, acetaminophen, and caffeine was effective and well tolerated in episodic tension-type headache, and significantly superior to acetaminophen with regard to being pain-free at 2 hours, headache response at 2 hours, and ability to return to daily activities, even in those with pain rated severe at baseline 5. A randomized, double-blind, placebo-controlled trial found that acetaminophen 1000 mg and naproxen 375 mg were significantly superior to placebo, but not significantly different from each other, in the treatment of tension-type headache 6.