What are the management options for tension-type headache?

From the Guidelines

Tension headaches can be effectively managed with ibuprofen (400 mg) or acetaminophen (1000 mg) for immediate relief, as suggested by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1.

Medication Options

• Ibuprofen (400 mg) is recommended for the treatment of acute tension-type headache, as it demonstrates statistically significant improvement in pain-free response at 2 hours 1.
• Acetaminophen (1000 mg) is also recommended for the treatment of acute tension-type headache, with statistically significant improvement in pain-free response at 2 hours 1.
• Amitriptyline at 50 mg and 100 mg is recommended for preventive treatment of chronic tension-type headache, as it significantly reduces monthly headache days 1.

Lifestyle Modifications

• Maintaining good posture can help prevent tension headaches.
• Practicing stress management techniques like deep breathing or meditation for 10-15 minutes daily can help reduce stress, a common trigger for tension headaches.
• Getting adequate sleep (7-9 hours nightly) and staying hydrated with at least 2 liters of water daily can help prevent tension headaches.
• Regular physical activity (30 minutes most days) can help reduce stress and improve overall health.

Nonpharmacologic Therapies

• Physical therapy is suggested for the management of tension-type headache, as it can help reduce headache frequency and intensity 1.
• Aerobic exercise or progressive strength training is suggested for the prevention of tension-type headache, as it can help reduce stress and improve overall health 1.
• Applying a warm or cold compress to the neck or head for 15 minutes can provide relief by relaxing muscles or reducing inflammation.

Trigger Identification and Avoidance

• Common triggers for tension headaches include stress, poor sleep, dehydration, and prolonged screen time.
• Identifying and avoiding these triggers can help prevent tension headaches.
• If headaches persist despite these measures, or if they're accompanied by severe symptoms like fever or vision changes, medical attention should be sought as this could indicate a more serious condition.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Tension Headache Management

• Tension-type headache (TTH) is the most prevalent neurological disorder worldwide, characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity 2.
• The diagnosis of TTH is based on headache history and the exclusion of alternative diagnoses, with clinical criteria provided by the International Classification of Headache Disorders, third edition 2.
• Pharmacological therapy is the mainstay of clinical management and can be divided into acute and preventive treatments, with simple analgesics being widely regarded as first-line medications for the acute treatment of TTH 2.
• Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and recommended treatments include amitriptyline, venlafaxine, and mirtazapine, as well as some selected non-pharmacological therapies 2.

Non-Pharmacological Management

• Non-pharmacological management of persistent headaches associated with neck pain, such as tension-type or cervicogenic headaches, can include low-load endurance craniocervical and cervicoscapular exercises, general exercise, multimodal care, and clinical massage 3.
• Manual therapy, such as manipulation with or without mobilization, can be considered as an adjunct therapy to exercise to treat patients with cervicogenic headaches 3.
• The management of tension-type and cervicogenic headaches should be patient-centred, with care provided in partnership with the patient and involving the patient in care planning and decision making 3.

Considerations in Specific Populations

• In the elderly, the initial evaluation of patients with a new-onset headache or a change in a pre-existing headache pattern should be directed towards excluding secondary headache disorders, which have a higher prevalence in this age group 4.
• The lifetime prevalence of TTH ranges between 30 and 78%, and the 1-year prevalence in individuals over the age of 55 years is 35.8% (27.8% in men, 42.4% in women) 4.
• TTH has a major socioeconomic impact due to its high prevalence and possible association with medical and psychiatric co-morbidities 4.