From the Guidelines
Tension headaches can be effectively treated with ibuprofen (400 mg) or acetaminophen (1000 mg) for acute relief, and amitriptyline (50 mg or 100 mg) for preventive treatment. According to the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1, these medications demonstrate statistically significant improvement in pain-free response at 2 hours for acute treatment, and significant reduction in monthly headache days for preventive treatment.
Key Treatment Options
- Ibuprofen (400 mg) or acetaminophen (1000 mg) for acute relief 1
- Amitriptyline (50 mg or 100 mg) for preventive treatment 1
- Aerobic exercise or physical therapy (PT) for prevention of tension-type headache (TTH) and migraine 1
Lifestyle Changes
- Applying a heating pad or ice pack to the neck or the back of the head for 10-15 minutes several times a day to relax tense muscles
- Stress management techniques including deep breathing exercises, meditation, or gentle yoga to reduce headache frequency
- Ensuring hydration by drinking 8-10 glasses of water daily
- Maintaining regular sleep patterns with 7-8 hours nightly
- Practicing good posture to prevent muscle tension
Important Considerations
- Tension headaches occur when muscles in the neck, face, and scalp contract due to stress, poor posture, or eye strain, causing a band-like pressure around the head
- If headaches are severe, persistent, or accompanied by other symptoms like fever or vision changes, consult a healthcare provider for proper evaluation 1
From the Research
Treatment Options for Tension Headache
- Simple analgesics, such as paracetamol and ibuprofen, have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of tension-type headache 2.
- Preventive treatment should be considered in individuals with frequent episodic and chronic tension-type headache, and if simple analgesics are ineffective, poorly tolerated, or contraindicated 2.
- Recommended preventive treatments include amitriptyline, venlafaxine, and mirtazapine, as well as some selected non-pharmacological therapies 2.
Comparison of Paracetamol and Ibuprofen
- Ibuprofen showed better efficacy than paracetamol for pain-free status at 2 hours, while paracetamol showed better efficacy than ibuprofen for pain-free status at 1 hour 3.
- Paracetamol was associated with the lowest likelihood of rescue medication use, and ibuprofen was associated with a lower likelihood of the occurrence of any events and gastrointestinal adverse events compared with placebo and paracetamol 3.
- Both paracetamol and ibuprofen showed better efficacy than placebo in treating episodic tension-type headache, with no statistically significant difference in efficacy between the two drugs 3.
Clinical Trials and Studies
- A single-dose, double-blind, randomized clinical trial found that 400 mg of ibuprofen was significantly more effective than 1,000 mg of acetaminophen in treating muscle contraction headache 4.
- A systematic review and network meta-analysis found that paracetamol and ibuprofen were effective in treating episodic tension-type headache, with ibuprofen showing better efficacy at 2 hours and paracetamol showing better efficacy at 1 hour 3.
Note on Other Conditions
- Macrophage activation syndrome associated with rheumatic diseases has different cytokine profiles, but this is not directly relevant to the treatment of tension headache 5.