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Tension headache - Treatment
Last reviewed: 06.07.2025
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Treatment for tension headaches
Only a comprehensive approach aimed at normalizing the patient's emotional state (depression treatment) and eliminating dysfunction of the pericranial muscles (reducing muscle tension) can alleviate the course of tension headaches and prevent the chronicity of cephalgia. The most important factor in the successful treatment of tension headaches is the relief and, if possible, prevention of drug abuse.
Basic principles of treating tension headaches
- Treatment and prevention of emotional and personality disorders: depression, anxiety, phobias, somatoform disorders, etc.
- Treatment and prevention of muscle tension (pericranial muscle tension).
- Relief/prevention of drug abuse.
As a result of these measures, pain and muscle-tonic syndrome are reduced, the transformation of episodic tension headaches into chronic ones is prevented, and the quality of life is improved.
The groups of drugs used to treat tension-type headaches (mainly frequent episodic and chronic tension-type headaches) are listed below.
Tension headache treatment regimen
- Pharmacotherapy.
- Antidepressants [amitriptyline, selective serotonin reuptake inhibitors (paroxetine, fluoxetine, sertraline, etc.), selective serotonin and norepinephrine reuptake inhibitors (milnacipran, duloxetine, venlafaxine)].
- Muscle relaxants (tizanidine, tolperisone).
- NSAIDs (acetylsalicylic acid, diclofenac, ketoprofen, naproxen).
- In case of a combination of tension headache and migraine - drugs for the prophylactic treatment of migraine (beta-blockers, calcium channel blockers, anticonvulsants).
- Non-drug methods.
- Relaxation therapy.
- Behavioural therapy (development of coping strategies).
- Biofeedback.
- Acupuncture, massage, manual therapy.
- Monitor the amount of painkillers you take!
The most effective are antidepressants, muscle relaxants and NSAIDs (the latter should be prescribed with caution due to the risk of drug abuse). Recently, in addition to amitriptyline and selective serotonin reuptake inhibitors, antidepressants from the group of selective serotonin and norepinephrine reuptake inhibitors (milnacipran, duloxetine) and anticonvulsants (topiramate, gabapentin, etc.) have been used to treat severe cases of chronic tension headache. When migraine and tension headache are combined, traditional migraine prevention agents should be used: beta-blockers, calcium channel blockers, anticonvulsants.
A number of studies have shown the effectiveness of botulinum toxin in tension headaches associated with pericranial muscle tension.
For many patients, especially those with severe depression, persistent psychological conflict and muscle tension, non-drug methods have a good effect: psychotherapy, psychological relaxation, biofeedback, progressive muscle relaxation, neck massage, fitness, water treatments, etc.
Pain relief
Most episodic tension-type headaches are mild to moderate in intensity. Most patients respond well to over-the-counter analgesics (such as acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs). If the headaches are not very long-lasting (less than 4 hours) and occur no more than once a week, episodic use of these medications may be appropriate. However, if headaches occur more than once a week, analgesics should be used with caution because of the risk of rebound headache. Although muscle relaxants (eg, diazepam, baclofen, dantrolene, cyclobenzaprine) are sometimes used empirically for the treatment of tension-type headaches, their effectiveness has not been demonstrated in clinical trials. Theoretically, these drugs may reduce pain by relaxing pericranial muscles, but in practice they are often ineffective.
Preventive treatment for tension headaches
Preventive treatment is indicated when tension headaches occur more than 3 days a week. The drugs of choice in this case are tricyclic antidepressants, primarily amitriptyline. Nonsteroidal anti-inflammatory drugs, valproic acid, other antidepressants (for example, doxepin, maprotiline, fluoxetine), and the anxiolytic buspirone are also used.