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Tension headache: treatment
Last reviewed: 19.10.2021
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Treatment of tension headache
Only an integrated approach aimed at normalizing the patient's emotional state (treating depression) and eliminating dysfunction of pericranial muscles (reducing muscle tension) makes it easier to relieve the tension headache and prevent the chronicization of cephalalgia. The most important factor for successful treatment of tension headache is cupping, and, if possible, prevention of drug abusus.
The main principles of the treatment of tension headaches
- Treatment and prevention of emotional and personal disorders: depression, anxiety, phobias, somatoform disorders, etc.
- Treatment and prevention of muscular tension (tension of pericranial muscles).
- Cupping / prevention of drug abusus.
As a result of these measures, pain and muscle-tonic syndrome are reduced, the transformation of episodic tension headache into chronic is prevented and quality of life is improved.
The groups of drugs used to treat tension headaches (mainly frequent episodic and chronic tension headaches) are listed below.
Treatment of tension headache
- Pharmacotherapy.
- Antidepressants [amitriptyline, selective serotonin reuptake inhibitors (paroxetine, fluoxetine, sertraline, etc.), selective serotonin and noradrenaline reuptake inhibitors (milnacipran, duloxetine, venlafaxine)].
- Miorelaxants (tizanidine, tolperisone).
- NSAIDs (acetylsalicylic acid, diclofenac, ketoprofen, naproxen).
- When combined tension headache with migraine - drugs for preventive treatment of migraine (beta-adrenoblockers, calcium channel blockers, anticonvulsants).
- Non-pharmacological methods.
- Relaxation therapy.
- Behavioral therapy (development of coping strategies).
- Biological feedback.
- Acupuncture, massage, manual therapy.
- Control of the number of pain medications taken!
The most effective antidepressants, muscle relaxants and drugs from the NSAID group (the latter should be administered with caution because of the risk of drug abusus). For the treatment of severe cases of chronic tension headache, antidepressants from the group of selective serotonin and noradrenaline reuptake inhibitors (milnacipran, duloxetine), as well as anticonvulsants (topiramate, gabapentin, etc.) have recently been used along with amitriptyline and selective serotonin reuptake inhibitors. When combined with migraine and tension headache, traditional migraine prevention drugs should be used: beta-blockers, calcium channel blockers, anticonvulsants.
A number of studies have shown the effectiveness of botulinum toxin in the headache of tension, combined with the tension of pericranial muscles.
In many patients, especially in the presence of severe depression, persistent psychological conflict and muscle tension, the non-drug methods have a good effect: psychotherapy, psychological relaxation, biological feedback, progressive muscle relaxation, collar zone massage, fitness, water procedures, etc.
Pain relief
In most cases, episodic tension headache has mild or moderate intensity. In most patients, conventional non-prescription analgesics (such as cocacetaminophen) or non-steroidal anti-inflammatory drugs are quite effective. If the pain is not too long (no more than 4 hours) and occurs no more often than once a week, then the practice of episodic intake of these drugs is fully justified. But if headaches occur more than once a week, then analgesics should be used with caution because of the risk of a ricochet headache. Although muscle relaxants are sometimes empirically used for the treatment of tension headaches (eg, diazepam, baclofen, dantrolene, cyclobenzaprine), their efficacy has not been proven in clinical trials. Theoretically, these drugs can reduce pain by relaxing the pericranial muscles, but in practice they often prove ineffective.
Preventive treatment of tension headache
Preventive treatment is indicated in the case when the tension headache is noted more often than 3 days a week. The drugs of choice in this case are tricyclic antidepressants, primarily amitriptyline. Non-steroidal anti-inflammatory drugs, valproic acid, other antidepressants (for example, doxepin, maprotiline, fluoxetine), as well as anxiolytic buspirone are also used.