What are the treatment options for aborting a tension-type headache?

From the Guidelines

To abort a tension headache, take ibuprofen (400 mg) or acetaminophen (1000 mg) as these demonstrate statistically significant improvement in pain-free response at 2 hours 1.

Abortive Therapies for Tension-Type Headache

When considering abortive therapies for tension-type headache, the goals are to rapidly alleviate pain and restore function.

• The recommended dose of ibuprofen is 400 mg, and for acetaminophen, it is 1000 mg, as lower doses of acetaminophen (e.g., 500 to 650 mg) did not show statistically significant improvement 1.
• It is essential to combine medication with relaxation techniques such as applying a warm or cold compress to the neck or temples, practicing deep breathing exercises, or gentle neck stretches.
• Finding a quiet, dark room to rest can also be beneficial, and staying hydrated by drinking water is crucial as dehydration can worsen headaches.
• Caffeine may help some people, so a small cup of coffee could provide relief.

Underlying Causes

Tension headaches typically result from muscle tension, stress, poor posture, or eye strain, so addressing these underlying causes is important.

• If the headache is severe, accompanied by other symptoms like fever or confusion, or if you experience frequent tension headaches, consult a healthcare provider as this could indicate a more serious condition or the need for preventive treatment.

Preventive Therapies

For preventive treatment of chronic tension-type headache, amitriptyline at 50 mg and 100 mg is recommended as both doses were found to significantly reduce monthly headache days 1.

• However, clinicians should be aware of anticholinergic adverse effects, especially among older patients and those with multiple cardiac comorbid conditions, as well as the potential for overdose.
• OnabotulinumtoxinA for chronic TTH did not show statistically significant improvement in critical outcomes and is not recommended 1.

From the Research

Aborting a Tension Headache

• Tension-type headache (TTH) is a highly prevalent disorder that can be treated with nonpharmacological and pharmacological methods 2, 3.
• Simple analgesics and nonsteroidal anti-inflammatory drugs are recommended for the treatment of episodic TTH, while combination analgesics containing caffeine are considered second-choice drugs 2, 3.
• The tricyclic antidepressant amitriptyline is the drug of first choice for the prophylactic treatment of chronic TTH, with mirtazapine and venlafaxine as second-choice drugs 2, 3, 4.
• Nonpharmacological treatments such as electromyographic (EMG) biofeedback, cognitive-behavioral therapy, and relaxation training have also been shown to be effective in treating TTH 2, 3, 5.
• A study found that combined therapy of tricyclic antidepressant medication and stress management therapy was more likely to produce clinically significant reductions in headache index scores than monotherapy 5.
• It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache 2, 3.

Treatment Options

• Simple analgesics: effective for acute treatment of TTH 2, 3, 4.
• Nonsteroidal anti-inflammatory drugs: effective for acute treatment of TTH 2, 3.
• Amitriptyline: first-choice drug for prophylactic treatment of chronic TTH 2, 3, 4.
• Mirtazapine and venlafaxine: second-choice drugs for prophylactic treatment of chronic TTH 2, 3, 4.
• EMG biofeedback, cognitive-behavioral therapy, and relaxation training: effective nonpharmacological treatments for TTH 2, 3, 5.

Important Considerations

• Accurate diagnosis is essential before initiating treatment 3.
• Treatment should be individualized to suit the patient's needs 2, 3.
• Frequent and excessive use of analgesics should be avoided to prevent medication-overuse headache 2, 3.