Tension Headache: Drug Therapy

Therapy goals

  • Prevention of tension headaches
  • Improvement of the symptomatology during an attack of tension headache

Therapy recommendations

Tension-type headaches often have only mild intensity and do not generally require analgesic (pain-relieving) treatment.

Episodic tension-type headaches can be divided into two forms:

  1. Without increased pain sensitivity of the pericranial muscles → non-opioid analgesics (paracetamol 500-1,000 mg, acetylsalicylic acid 500-1,000 mg, ibuprofen 200-400 mg or naproxen: 500-1,000 mg; paracetamol; if necessary, also 500-1,000 mg metamizo.Means of first choice in children) are equal to the external application of peppermint oil (Oleum menthae piperitae) in 10% ethanolic solution.
  2. With increased pain sensitivity of the pericranial muscles → tizanidine due tomuscle tone-reducing effects.

Other therapy recommendations:

  • Acute tension headache: paracetamol, if necessary also ibuprofen (non-opioid analgesics); caffeine (from 100 mg ) is thereby considered an analgesic adjuvant with good tolerability.
  • Chronic tension headache: prophylactic administration of amitriptyline (tricyclic andidepressants): first-line agentDosing information:
    • Choosing a low starting dose and dosing up slowly reduces the number of treatment discontinuations for these agents, which are often associated with adverse side effects.
    • An assessment of the efficacy of drug prophylaxis should generally be made no earlier than 8 weeks after reaching the target dose, although improvement may occur in part as early as the first month of treatment.
  • Pharmacotherapy must be supported by general measures (stress management, etc.; see also under “Further therapy“).

Note

  • The following thresholds apply to the development of drug-induced headache (drug-induced headache):
    • Use of monoanalgesics for more than 15 days/month.
    • Taking combination analgesics on more than 10 days/month
    • Taking combinations of different analgesics on more than 10 days/month

Supplements (dietary supplements; vital substances)

Suitable dietary supplements should contain the following vital substances:

  • Vitamins (vitamin D (calciferols))
  • Minerals (calcium, magnesium)

Note: The listed vital substances are not a substitute for drug therapy. Food supplements are intended to supplement the general diet in the particular life situation.