Many different medication options are available for tension headaches. Ideal treatment for tension headaches is the medication that is most effective at the lowest dose and has the fewest potential side effects. If headaches are not relieved, the dose may be increased or another type of drug can be tried.
Abortive Therapy
Initial abortive therapies for tension headaches include non-prescription pain medications (also called analgesics) such as aspirin and acetaminophen (Tylenol). Usually medications like these are well tolerated, although some individuals may experience upset stomach when taking aspirin. Continually taking non-prescription analgesics daily for more than 2 weeks or taking higher than recommended doses can lead to rebound headaches. If an analgesic is being used with increasing frequency and less relief is occurring, other treatment options should be tried.
When aspirin or acetaminophen is not effective, a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) is usually the next step for pain relief. Some NSAIDs are available both without a prescription (usually in lower doses) and with a prescription (usually in higher doses). Common side effects include stomach irritation, which may be minimized if the medication is taken with food. Because individuals with kidney problems may be at increased risk for side effects, they should not begin taking an NSAID before discussing its use with a healthcare provider.
Other prescription treatments include muscle relaxants, such as carisoprodol (Soma) and cyclobenzaprine (Flexeril), and certain antidepressants (however, there is no evidence to support the effectiveness of these agents as abortive therapy). Both of these types of medications may cause drowsiness, however. A combination medication that includes isometheptene mucate, dichloralphenazone, and acetaminophen (Midrin, Duradrin) may also be used as abortive treatment for tension headaches. Caution should be used if it is taken because it may be habit-forming.
Prophylactic/Preventive Therapy
To prevent tension headaches, many different antidepressants may be effective for individuals with and without depressive symptoms. The antidepressant needs to be taken continually. Side effects depend on the individual drug, but they are usually mild. They may include constipation, dizziness, drowsiness, dry mouth, nausea, and weight gain.
In the case of tension headaches, psychophysiologic therapies such as stress management, relaxation training and biofeedback training may significantly reduce headache activity.
