From the Guidelines
For a one-week treatment of tension headaches, I recommend starting with over-the-counter analgesics such as ibuprofen (400mg) or acetaminophen (1000mg) as needed, due to their statistically significant improvement in pain-free response at 2 hours 1.
Key Considerations
- The goals of treating acute tension-type headache (TTH) include rapid and sustained alleviation of pain and restoration of function.
- Critical TTH outcomes included time to pain freedom and headache intensity 2 hours after treatment.
- Ibuprofen (400mg) and acetaminophen (1000mg) demonstrate statistically significant improvement in pain-free response at 2 hours, making them suitable options for acute TTH treatment 1.
Treatment Approach
- Start with ibuprofen (400mg) or acetaminophen (1000mg) at the first sign of headache for best results.
- Consider incorporating non-pharmacological approaches, including stress management techniques, adequate hydration, regular sleep patterns, and brief breaks from screen time.
- Apply a cold or warm compress to the forehead or neck for 15-20 minutes as needed.
Additional Considerations
- If the headaches are severe or persistent despite these measures, consider consulting a healthcare provider for further evaluation.
- Amitriptyline at 50mg and 100mg is recommended for preventive treatment of chronic TTH, but its use should be weighed against potential anticholinergic adverse effects, especially among older patients and those with multiple cardiac comorbid conditions 1.
- Aerobic exercise or physical therapy received a “weak for” recommendation for the prevention of both migraine and TTH, and can be considered as part of a comprehensive treatment plan 1.
From the Research
Treatment of Tension-Type Headache
- The treatment of tension-type headache (TTH) can be divided into acute and preventive treatments 2.
- Simple analgesics, such as paracetamol and NSAIDs, have been shown to be effective in the acute treatment of TTH 3.
- Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and may include medications such as amitriptyline, venlafaxine, and mirtazapine 2.
Effectiveness of Amitriptyline
- Amitriptyline is a tricyclic antidepressant that has been shown to be effective in the treatment of chronic TTH 4.
- A review of the literature found that amitriptyline was effective in reducing headache frequency and severity in patients with chronic TTH 4.
- Another study found that combined therapy with amitriptyline and stress management therapy was more effective than monotherapy in reducing headache activity and improving quality of life 5.
Duration of Treatment
- The optimal duration of treatment for TTH is not well established, but it is generally recommended that patients with frequent or chronic TTH receive preventive treatment for at least 6-12 months 2.
- There is limited evidence on the effectiveness of short-term treatment (e.g. 1 week) for TTH, and more research is needed to determine the optimal treatment duration for this condition.