From the Guidelines
Tension headache treatment involves a combination of pharmacologic and nonpharmacologic interventions. The primary goal of treatment is to alleviate pain and restore function.
Pharmacotherapies
- Ibuprofen (400 mg) and acetaminophen (1000 mg) are recommended for the treatment of acute tension-type headache (TTH) 1.
- Amitriptyline at 50 mg and 100 mg is recommended for preventive treatment of chronic TTH 1.
Nonpharmacologic Therapies
- Physical therapy (PT) and aerobic exercise are recommended for the management of TTH and migraines 1.
- Behavioral medicine interventions, such as cognitive behavioral therapy and mindfulness-based therapies, may be considered, but the evidence is insufficient to recommend for or against their use 1. It is essential to note that the treatment of tension headache should be individualized, taking into account the patient's values, preferences, and comorbid conditions. Clinicians should work with their patients to craft treatment plans that address their specific needs and circumstances.
From the Research
Treatment Options for Tension Headache
- Acute treatment of tension-type headache is more effective with NSAIDs (ibuprofen 400-800mg, naproxen 550-825mg, ketoprofen 50-75mg) than with aspirin or paracetamol 2
- Caffeine-containing preparations of NSAIDs are slightly superior, but should not be taken frequently to avoid headache chronification 2
- For chronic tension-type headache, relaxation therapies with EMG biofeedback and tricyclics have about the same efficacy rate of 40-50% 2
- Physical therapy and acupuncture are in general less effective, but may be valuable options for patients with frequent tension-type headache 2, 3
Pharmacological Treatment
- Simple or combined analgesics are the mainstay of acute treatment 4
- Prophylactic treatment is needed in case of attacks that are frequent and/or difficult to treat, with tricyclic antidepressants (such as amitriptyline) being the first drugs of choice 4, 5, 3
- Other antidepressants, such as mirtazapine and venlafaxine, may also be effective 4, 3
- Non-pharmacological prophylactic methods, including certain types of psychotherapy and acupuncture, may also be effective 4, 3