Treatment:

Management of tension-type headaches focuses in the short term on treating acute attacks, and in the long term on preventing recurrent episodes of headache. In general, short-term treatment of tension-type headache involves drugs (mainly pain relievers) while long-term preventive measures include both drug and non-drug approaches. With medications, relaxation training, lifestyle changes, and other therapies, nearly all patients can be helped.

Treatment for Acute Attacks of Tension-Type Headaches

Fortunately, most acute tension-type headaches get better without any treatment, and simple over-the-counter pain relievers such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) can treat mild symptoms. Aspirin or ibuprofen (Motrin) are usually the first choices, followed by naproxen (Aleve). Some patients may also find helpful medications that combine a pain reliever with caffeine.

Massage therapy may also be useful for treating acute episodes of tension-type headache.

Treatment and Prevention of Frequent and Chronic Tension-Type Headaches

Daily preventive treatment is recommended for patients who experience at least two headache attacks a month. Preventive treatments do not work as well when patients are overusing pain-relief medication, so doctors may recommend stopping and withdrawing from analgesics before beginning preventive approaches.

The goals of preventive treatment are to reduce the frequency and severity of headache attacks, and to improve the response to pain medication.

Preventive treatment for tension-type headache includes:

• Drug treatment with an antidepressant, usually the tricyclic antidepressant amitriptyline
• Relaxation training and biofeedback
• Stress management through cognitive-behavioral therapy

Studies indicate that best results are achieved when drug treatment is combined with relaxation or stress-management training.

Withdrawing from Medications After Medication-Overuse Headaches

If headaches develop because of medication overuse, the patient cannot recover without stopping the drugs. (If caffeine is the culprit, a person may only need to reduce coffee or tea drinking to a reasonable level, not necessarily stop drinking it altogether.) The patient usually has the option of stopping abruptly or gradually and should expect the following course:

• Most headache drugs can be stopped abruptly, but the patient should be sure to check with the doctor before withdrawal. Certain non-headache medications, such as anti-anxiety drugs or beta-blockers, require gradual withdrawal under medical supervision.
• If the patient chooses to taper off standard headache medications, withdrawal should be completed within 3 days or less. Otherwise the patient may become discouraged.
• No matter which approach is used for stopping medication, the patient must expect a period of worsening headache for a few days afterward. Alternative pain relievers may be administered during the first days to help withdrawal.
• Most people feel better within 2 weeks, although headache symptoms can persist up to 16 weeks (and in rare cases even longer).