Indomethacin Not Recommended for Chronic Tension Headache Treatment
Indomethacin is not recommended for chronic tension headache treatment due to insufficient evidence supporting its efficacy and significant risks of gastrointestinal side effects and potential medication overuse headache. 1
Evidence Against Indomethacin Use
- The Journal of Neurology, Neurosurgery and Psychiatry explicitly states that indomethacin lacks sufficient evidence for chronic tension headache treatment 1
- Indomethacin carries significant risks:
- Gastrointestinal side effects
- Potential to cause medication overuse headache
- Delayed elimination with chronic use, leading to increased plasma levels 2
Preferred Treatment Options
First-Line Treatments
- NSAIDs with better evidence profiles are recommended:
- Aspirin
- Ibuprofen
- Naproxen sodium 1
- Acetaminophen-aspirin-caffeine combinations have demonstrated efficacy 1
Important Medication Usage Guidelines
- Limit NSAID use to fewer than 15 days per month to prevent medication overuse headache 1
- Monitor for signs of medication overuse through headache diaries 1
Special Considerations
While indomethacin is not recommended for chronic tension headaches, it does have specific applications in other headache disorders:
Preventive Therapy Indications
Preventive therapy should be considered when:
- Headaches occur two or more times per month with disability for three or more days
- Rescue medications are used more than twice a week
- Acute treatments fail or are contraindicated 1
Non-Pharmacological Approaches
The following lifestyle modifications are recommended as part of comprehensive headache management:
- Regular meals
- Adequate hydration
- Sleep hygiene
- Stress management techniques
- Regular exercise programs 1
Caution and Pitfalls
- Despite some case reports suggesting efficacy in a small subgroup of patients with bilateral chronic headache 5, the overall evidence does not support indomethacin use for chronic tension headaches
- Overuse of indomethacin can lead to:
When treating chronic tension headaches, prioritize evidence-based NSAIDs and non-pharmacological approaches while avoiding indomethacin due to its unfavorable risk-benefit profile for this specific headache type.