From the Research
Current treatment guidelines for tension headaches recommend a stepwise approach starting with non-pharmacological interventions and over-the-counter medications, with acetaminophen (500-1000mg every 4-6 hours, maximum 4000mg daily) or NSAIDs like ibuprofen (400-600mg every 6-8 hours, maximum 3200mg daily) or naproxen sodium (550mg initially, then 275mg every 6-8 hours) as first-line options. For acute treatment, these medications have been shown to be effective in reducing headache symptoms, with a number needed to treat (NNT) of 22 for paracetamol 1000 mg compared with placebo to be pain free at two hours 1. Non-pharmacological approaches are essential and include:
- Stress management
- Regular physical activity
- Adequate sleep
- Proper hydration
- Trigger avoidance Physical therapy, massage, acupuncture, biofeedback, and cognitive behavioral therapy can also be beneficial. Patients should avoid medication overuse (limiting use to 2-3 days per week) to prevent rebound headaches. If headaches persist despite these measures, referral to a neurologist or headache specialist is warranted. These treatments work by reducing muscle tension, inflammation, and central pain sensitization that contribute to tension headaches. The most recent and highest quality study, a systematic review from 2016, supports the use of paracetamol and NSAIDs for acute treatment of tension-type headache 1.
For frequent or severe headaches, preventive therapy may include amitriptyline (10-25mg daily, gradually increasing to 25-75mg if needed) or other tricyclic antidepressants. However, the evidence for preventive medication is limited, and more research is needed to determine its effectiveness 2.
It's worth noting that the studies provided are of varying quality and age, with the most recent and highest quality study being from 2016 1. This study provides the best evidence for the treatment of tension headaches, and its findings should be prioritized in clinical decision-making.