What is the treatment for stress headaches?

Treatment of Stress Headaches

For stress headaches (tension-type headaches), first-line treatment is ibuprofen 400 mg or acetaminophen 1000 mg, which are both effective for pain relief. 1

Pharmacological Treatment Options

First-Line Treatments:

• NSAIDs:

  • Ibuprofen 400 mg (provides significant pain relief within 2 hours) 1, 2
  • Naproxen sodium 275-550 mg 1
  • Aspirin 650-1000 mg 3

• Acetaminophen:

  • 1000 mg dose (lower doses like 500-650 mg are less effective) 1, 4
  • Note: Acetaminophen alone at 1000 mg has been shown to be as effective as naproxen 375 mg for tension headaches 2

Combination Treatments:

• Aspirin + acetaminophen + caffeine combination is highly effective and recommended for more severe stress headaches 1
• This combination may provide better relief than single agents alone 1

Treatment Algorithm Based on Headache Severity

For Mild to Moderate Stress Headaches:

1. Start with ibuprofen 400 mg OR acetaminophen 1000 mg
2. If inadequate response after 2 hours, can take a second dose (being mindful of daily maximum limits)
3. For recurrent headaches, consider adding caffeine to enhance effectiveness

For Moderate to Severe Stress Headaches:

1. Use combination therapy (aspirin + acetaminophen + caffeine)
2. If ineffective, consider adding a muscle relaxant under physician supervision
3. For severe, persistent headaches, consider preventive therapy

Non-Pharmacological Approaches

Physical therapy and rehabilitation interventions have shown benefit for tension-type headaches 1:

• Thermal methods
• Trigger point massage
• Mobilization techniques
• Progressive muscle relaxation

Regular aerobic exercise (2-3 times weekly for 30-60 minutes) can help prevent recurrent stress headaches 1

Prevention for Chronic Stress Headaches

If headaches occur frequently (>15 days/month for 3+ months):

• Amitriptyline (25-100 mg daily) is recommended for prevention 1, 5
• Combined therapy (medication + stress management) provides better outcomes than either treatment alone 5

Important Cautions

• Avoid opioids and butalbital-containing medications for stress headaches as they can lead to dependency, rebound headaches, and eventual loss of efficacy 1
• Limit use of acute medications to no more than twice weekly to prevent medication overuse headache 1
• Monitor for rebound headaches with frequent use of analgesics 1
• Higher doses of acetaminophen (1000 mg) are more effective than lower doses (500-650 mg) 1, 4

Lifestyle Modifications

Addressing underlying stress factors is crucial:

• Regular sleep schedule
• Hydration
• Stress management techniques
• Regular physical activity
• Identification and avoidance of personal triggers

By following this stepped approach to treatment and incorporating both pharmacological and non-pharmacological strategies, most stress headaches can be effectively managed while minimizing the risk of medication overuse and chronic headache development.