Acute treatment — Tension type headaches that occur less than 15 times per month can usually be treated with a pain reliever.
Pain reliever — A pain reliever may be recommended first for the treatment of tension type headache. These drugs include:
●Acetaminophen (eg, Tylenol®)
●Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (eg, Motrin or Advil), indomethacin, or naproxen (eg, Naprosyn or Aleve).
Mild pain relievers are also available in combination with caffeine, which enhances the drug’s effect. As an example, Excedrin® contains a combination of acetaminophen-aspirin-caffeine. This combination may be recommended if a pain reliever alone does not relieve the headache.
Pain relievers should not be used too often because overuse can lead to medication-overuse headaches or chronic daily headaches. If you respond to a pain reliever, you should continue taking these with each headache. However:
●Do not use pain relievers more than nine days per month on average, or more than two doses per episode.
●If a pain reliever does not control your headache, talk to your healthcare provider for other suggestions.
People with gastritis (inflammation of the stomach), ulcers, kidney disease, and bleeding conditions should not take products containing aspirin or NSAIDs.
Combination medicines containing butalbital and opioids — Combinations of an opioid (narcotic) and a pain reliever are available, but are generally not recommended since they are habit-forming and can increase the risk of medication-overuse headaches and chronic daily headaches. Even so, such medications may be considered in special situations where simple pain relievers are ineffective or contraindicated (eg, women in the third trimester of pregnancy, patients with ulcers, severe kidney failure, or liver failure). When healthcare providers encounter patients who are using opioids and barbiturates inappropriately, a “stop or brake” policy may be put into place. The use of these medications is then either stopped, or the frequency of use is braked by limiting them to no more than two days per week and 18 tablets per month.
Preventive treatment — Preventive therapy is recommended for people with tension-type headaches that are frequent, long lasting, or account for a significant amount of total disability.
Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline. The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work.
It is common to feel tired when you start taking TCAs; this is not always an undesirable side effect since it can help improve sleep if you take TCAs in the evening. TCAs are generally started in low doses and increased gradually. Their full effect may not be seen for weeks to months.
Tricyclic antidepressants are sometimes used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache.