Treatment of Band-Like Tension Headache
For acute band-like tension headache, start with ibuprofen 400 mg or acetaminophen 1000 mg taken at headache onset. 1, 2
Acute Treatment Approach
First-Line Medications
- Ibuprofen 400 mg is the preferred initial treatment, demonstrating statistically significant pain-free response at 2 hours 1, 2
- Acetaminophen 1000 mg is equally effective as an alternative first-line option, also showing significant improvement in pain-free response at 2 hours 1, 2
- Take medication early in the headache episode for maximum effectiveness 2
Alternative Acute Options
- If ibuprofen is inadequate, consider naproxen sodium 550 mg as an alternative NSAID 2
- For severe attacks with nausea, add an antiemetic medication to improve treatment outcomes 2
- Combination preparations with caffeine may provide slightly superior relief but should not be used frequently to avoid medication overuse headache 3
Critical Medication Overuse Warning
- Limit acute medication use to no more than 2 days per week to prevent progression to chronic daily headache 2
- Avoid opioids and butalbital-containing analgesics due to high risk of dependence and medication overuse headache 2, 4
Preventive Treatment (For Chronic Tension-Type Headache)
When to Consider Prophylaxis
- Chronic tension-type headache (≥15 days per month) 1
- Very frequent episodic headaches 5
- Patients at risk of medication overuse headache 5
First-Line Prophylactic Agent
- Amitriptyline at 50-100 mg is the recommended preventive treatment, significantly reducing monthly headache days in chronic tension-type headache 1, 2
- Monitor for anticholinergic adverse effects, especially in older patients and those with cardiac comorbidities 2
- Amitriptyline has the most robust research evidence among prophylactic agents for frequent headaches 4, 6
Alternative Prophylactic Options
- Mirtazapine and venlafaxine have documented efficacy but are considered second-line 6
- Weaker evidence exists for gabapentin, topiramate, and tizanidine 6
Non-Pharmacological Approaches
- Physical therapy and aerobic exercise can be considered as adjunctive management options 2
- EMG biofeedback and cognitive behavioral therapy have approximately 40-50% efficacy rates, comparable to tricyclic antidepressants 3, 5
- Acupuncture has documented efficacy as a non-pharmacological preventive method 6
Important Caveats
NSAID Safety Considerations
- Use ibuprofen at the lowest effective dose for the shortest duration needed 7
- Increased risk of GI bleeding and ulcers, particularly with prolonged use, history of ulcers, concurrent corticosteroids/anticoagulants/SSRIs/SNRIs, smoking, alcohol use, or advanced age 7
- Avoid NSAIDs after 30 weeks of pregnancy and use cautiously between 20-30 weeks with monitoring 7