Tension Headaches - Treatment Overview

Treatment Overview

You can manage tension headaches by taking pain relievers that you can buy without a prescription, such as nonsteroidal anti-inflammatory drugs (NSAIDs) (for example, aspirin or ibuprofen). If you have chronic or severe tension headaches, you may need to take a prescription drug (such as an antidepressant) every day to reduce the pain and frequency of your headaches. You may also try complementary therapies (such as acupuncture, biofeedback, or meditation), to help lower stress, which may help reduce or prevent your headaches.

Initial treatment

When first treating tension headaches pain, you may try taking nonprescription drugs. These drugs usually have fewer side effects than prescription pain relievers. Also, you may be able to prevent or reduce tension headaches by learning what causes your headaches, such as stress or anxiety, and trying to avoid those triggers. For more information, see:

Identifying and avoiding tension headache triggers

Nonprescription drugs.Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, usually reduce the pain you get with a tension headache. But try to avoid taking nonprescription drugs more than 3 times a week, because you may get rebound headaches. Rebound headaches are different from tension headaches. They are usually triggered after pain medicine has worn off, prompting you to take another dose. Eventually, you get a headache whenever you stop taking the medicine.

Prescription drugs. If nonprescription drugs do not relieve your headache, your doctor may prescribe stronger medicine to treat your pain. You may be prescribed:

• Antidepressants such as mirtazapine (Remeron) and the tricyclic antidepressant amitriptyline. When taken daily, these medicines can help reduce how often tension headaches occur and how long they last.¹
• Seizure medicines or antianxiety drugs. These medicines are not often used to treat tension headaches.

In some cases your doctor may prescribe drugs such as barbiturates or narcotics when other drugs are ineffective. But these drugs can be habit-forming and should be used sparingly.

Should I take prescription drugs for tension headaches?

Stress management. Managing stress, anxiety, or depression may help reduce the frequency of tension headaches. The best approach to managing chronic tension headaches may be a combination of drugs and stress management therapies. Nonmedication methods for reducing stress may include:

• Biofeedback, a relaxation method to help you learn to control a body function that is not normally under conscious control, such as muscle tension.
• A relaxation exercise during which you focus on relaxing each muscle group. Relaxation exercises can help with tension headaches. When relaxation exercises and antidepressants are used together as treatment, the results are even better.³
• Acupuncture, which involves putting very thin needles into the skin at certain points on the body to produce energy flow along the body's meridians. Evidence specifically for tension headaches shows that acupuncture is no better than sham acupuncture (when needles are put into the skin, but not at the right points).⁴
• Transcutaneous electrical nerve stimulation (TENS), which may help reduce pain.
• Cognitive-behavioral therapy or problem-solving therapy during counseling sessions. Cognitive-behavioral therapy and problem-solving therapy can help with tension headaches. When cognitive-behavioral therapy or problem-solving therapy and antidepressants are used together as treatment, the results are even better.³
• Yoga.
• Meditation.

Ongoing treatment

It is important to have a good treatment plan for ongoing care of tension headaches, especially chronic tension headaches. You and your doctor will work together to find the best treatment to relieve or prevent your tension headaches. Generally, ongoing treatment includes using drugs to relieve your pain and practicing stress management techniques, such as relaxation exercises or meditation.

Ongoing treatment may involve finding the right drug for your headache, identifying and avoiding tension headache triggers, and avoiding rebound headaches that are caused by overusing pain relievers.

Identifying and avoiding tension headache triggers

Nonprescription drugs.Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, are often all you need to reduce the pain you get with a tension headache. But try to avoid taking nonprescription drugs more than 3 times a week, because you may get rebound headaches. Rebound headaches are different from tension headaches. They are usually triggered after pain medicine has worn off, prompting you to take another dose. Eventually, you get a headache whenever you stop taking the medicine.

Prescription drugs. If nonprescription drugs do not relieve your headache, your doctor may prescribe stronger medicine to treat your pain. You may be prescribed:

• Antidepressants such as mirtazapine (Remeron) and the tricyclic antidepressant amitriptyline. When taken daily, these medicines can help to reduce how often tension headaches occur and how long they last.¹
• Seizure medicines or antianxiety drugs. These medicines are not often used to treat tension headaches.

In some cases your doctor may prescribe drugs such as barbiturates or narcotics when other drugs are ineffective. But these drugs can be habit-forming and should be used sparingly.

Should I take prescription drugs for tension headaches?

Stress management. Managing stress, anxiety, or depression may help reduce how often tension headaches occur. The best approach to managing chronic tension headaches may be a combination of drug and stress management therapies. Methods of reducing stress may include:

• Biofeedback, a relaxation method to help you learn to control a body function that is not normally under conscious control, such as muscle tension.
• A relaxation exercise during which you focus on relaxing each muscle group. Relaxation exercises can help with tension headaches. When relaxation exercises and antidepressants are used together as treatment, the results are even better.³
• Acupuncture, which involves putting very thin needles into the skin at certain points on the body to produce energy flow along the body's meridians. Evidence specifically for tension headaches shows that acupuncture is no better than sham acupuncture (when needles are put into the skin, but not at the right points).⁴
• Transcutaneous electrical nerve stimulation (TENS), which may help reduce pain.
• Cognitive-behavioral therapy or problem-solving therapy during counseling sessions. Cognitive-behavioral therapy and problem-solving therapy can help with tension headaches. When cognitive-behavioral therapy or problem-solving therapy and antidepressants are used together as treatment, the results are even better.³
• Yoga.
• Meditation.

Treatment if the condition gets worse

If you continue to have tension headaches while you are getting treatment, you and your doctor may want to try another treatment plan. Changing drugs, trying a different type of pain reliever, or taking other drugs daily (such as antidepressants) may help improve your symptoms or reduce the number of tension headaches you develop. If you have already tried several different types of drugs, your doctor may order tests (such as an MRI or CT scan) to rule out other causes of your headaches.

What To Think About

Even with treatment, you will most likely continue to have some tension headaches. For most people, successful treatment means you get headaches less often and they are less severe when you do get them. It is rare for any treatment to be able to stop all tension headaches. Finding an effective drug may take some time and patience. It may take several attempts to find the drug that works best for you.

If you think your tension headaches could be related to depression or anxiety, be sure to let your doctor know. You may be able to stop or reduce the occurrence of tension headaches with proper treatment of these conditions.

Botulinum toxin type A (BTX-A) is sometimes injected into the muscles in the face and head, to reduce contractions or spasms that in the past were thought to produce tension headaches. But BTX-A injections do not seem to help with symptoms of tension headaches.¹ And BTX-A may cause weakness of the facial muscles and may affect swallowing.