What are the treatment options for tension headaches?

From the Guidelines

Tension headache treatment should prioritize ibuprofen (400 mg) or acetaminophen (1000 mg) for acute relief, and amitriptyline for preventive treatment, as these options have demonstrated statistically significant improvements in pain-free response and reduction in monthly headache days 1.

Treatment Options

• Medications:
  • Ibuprofen (400 mg) or acetaminophen (1000 mg) for acute treatment, as they demonstrate statistically significant improvement in pain-free response at 2 hours 1.
  • Amitriptyline at 50 mg and 100 mg for preventive treatment, as both doses significantly reduce monthly headache days 1.
• Non-pharmacologic interventions:
  • Aerobic exercise or progressive strength training, which received a “weak for” recommendation for the prevention of both migraine and TTH 1.
  • Physical therapy (PT), which received a “weak for” recommendation and is beneficial in the management of migraine and TTH 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 when prescribing amitriptyline 1.
• OnabotulinumtoxinA for chronic TTH did not show statistically significant improvement in critical outcomes and is not recommended 1.
• The benefits of PT outweighed the likelihood of AEs, which were not explicitly reported in the studies reviewed, although supervised PT is generally considered safe 1.

From the Research

Tension Headache Treatment Options

• The treatment options for tension headaches include over-the-counter pain relievers such as acetaminophen and aspirin 2, 3, 4, 5.
• Studies have shown that acetaminophen (1000 mg) and aspirin (650 mg) are clinically similar in treating tension headaches, with both being superior to placebo 2.
• Naproxen (375 mg) has also been found to be effective in treating tension-type headaches, with similar efficacy to acetaminophen (1000 mg) 3.
• A meta-analysis of four randomized, double-blind, placebo-controlled, crossover studies found that a fixed combination of acetylsalicylic acid, acetaminophen, and caffeine was more effective than acetaminophen alone in episodic tension-type headache 6.

Efficacy of Treatment Options

• Acetaminophen (1000 mg) has been shown to provide a small benefit in terms of being pain-free at two hours for people with frequent episodic tension-type headache 4.
• Aspirin (1000 mg) has been found to be statistically more effective than placebo in treating episodic tension-type headache, with a response rate of 75.7% 5.
• The combination of acetylsalicylic acid, acetaminophen, and caffeine has been found to be effective and well tolerated in episodic tension-type headache, with a significantly higher proportion of headache episodes being pain-free at 2 hours compared to acetaminophen alone 6.

Safety and Tolerability

• Acetaminophen (1000 mg) has been found to have a similar incidence of adverse events compared to placebo 4.
• Aspirin (1000 mg) has been found to have a low incidence of adverse events, with no safety concerns arising 5.
• The combination of acetylsalicylic acid, acetaminophen, and caffeine has been found to be generally well tolerated, with a low incidence of adverse events 6.