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Treatments and drugs

By Mayo Clinic staff

Some people with tension headaches don't seek medical attention and try to treat the pain on their own. The problem with that is that repeated use of over-the-counter (OTC) pain relievers can actually cause overuse headaches.

A variety of medications, both OTC and prescription, are available to stop or reduce the pain of an existing headache attack, including:

• Pain relievers. Simple OTC pain relievers are usually the first line of treatment for reducing headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Prescription medications include naproxen (Naprosyn), indomethacin (Indocin) and ketorolac (Ketorolac Tromethamine). Acetaminophen (Tylenol, others) may be less effective in treating tension headache pain, and more likely to cause medication overuse headaches.
• Combination medications. Aspirin or acetaminophen or both are often combined with caffeine or a sedative drug in a single medication. For example, Excedrin combines aspirin, acetaminophen and caffeine. Combination drugs may be more effective than are single-ingredient pain relievers. Although many combination drugs are available OTC, those containing sedatives can be obtained only by prescription because they may be addictive and can lead to chronic daily headache. Use them only with careful monitoring by your doctor.
• Triptans and narcotics. For people who experience both migraines and episodic tension headaches, a triptan can effectively relieve the pain of both headaches. Studies have shown that the injectable form of sumatriptan (Imitrex, Sumavel Dosepro), a common migraine medication, may also relieve symptoms of chronic tension headache. Opiates, or narcotics, are rarely used because of their side effects and potential for dependency.

Pain medications don't cure headaches; they just relieve the symptoms temporarily. Over time, painkillers and other medications may lose their effectiveness or they might even cause headaches. To avoid the development of medication overuse headaches, don't use over-the-counter pain relievers for more than nine days a month. In addition, all medications have side effects. If you take medications regularly, including products you buy over-the-counter, discuss the risks and benefits with your doctor. Also, remember that pain medications aren't a substitute for recognizing and dealing with the stressors that may be triggering your headaches.

Preventive medications
Certain medications taken at regular intervals may reduce the frequency and severity of attacks. Your doctor may prescribe these if you have frequent headaches or have tension headaches that aren't relieved by pain medication and nondrug therapy such as stress management. Your doctor may also recommend preventive medication if your headache pain becomes disabling or causes you to overuse pain medication, or if you can't take pain medication because of other medical conditions.

Doctors may prescribe antidepressants to prevent tension headache, especially the chronic form. These drugs aren't painkillers. Rather, they work to stabilize the levels of brain chemicals such as serotonin, which may be involved in the development of a headache. You don't have to have depression in order to use these drugs.

Preventive medications may include:

• Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and nortriptyline (Pamelor), are the most commonly used medications to prevent tension headache. They're effective against both the episodic and chronic forms. Side effects of these medications may include weight gain, drowsiness and dry mouth.
• Selective serotonin reuptake inhibitors (SSRIs). Antidepressants such as paroxetine (Paxil), venlafaxine (Effexor, Venlafaxine HCL Er) and fluoxetine (Prozac, Sarafem, others) produce fewer side effects than do the tricyclic antidepressants but generally aren't considered effective for tension headaches.
• Anticonvulsants and muscle relaxants. Other medications that may prevent tension headache include anticonvulsants, such as topiramate (Topamax) and gabapentin (Neurontin), and muscle relaxants, such as tizanidine (Zanaflex).

Preventive medications may require several weeks or more to build up in your nervous system before they take effect. So don't get frustrated if you haven't seen improvements shortly after you begin taking the drug — it may take a couple of months or longer. Also be aware that overusing caffeine or painkillers for acute relief may reduce the effect of a preventive drug.

To obtain the greatest benefit from preventive medication, keep your use of acute pain relievers to a minimum. Your doctor will monitor your treatment to see how the preventive medication is working. If your headaches are under control, your dose of medication may be reduced gradually over time.

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