Tension headache medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]
Overview
Episodic tension-type headaches generally respond well to over-the-counter analgesics, such as paracetamol, ibuprofen or aspirin. Simple analgesic monotherapy such as NSAIDS or aspirin are recommended (Grade 1A) for episodic TTH treatment requiring patients. Simple analgesic monotherapy is used in combination with caffeine for TTH patients who are unresponsive or have a poor response to analgesic monotherapy (Grdae 2A). Combination therapies including opioids or butalbital are not recommended as first line agents for TTH Rx (Grade 1C). Inpatient treatment for severe TTH can be treated in addition to the above mentioned treatment with chlorpromazine, metoclopramide, combination of metoclopramide and diphenhydramine and intramuscular ketorolac.
Medical Therapy
- Episodic tension-type headaches generally respond well to over-the-counter analgesics, such as paracetamol, ibuprofen or aspirin.
- Simple analgesic monotherapy such as NSAIDS or aspirin are recommended (Grade 1A) for episodic TTH treatment requiring patients
- Ibuprofen 400mg or naproxen sodium 220 /550mg or aspirin 650-1000mg
- Acetaminophen is less effective than NSAIDS/aspirin, but preferred in pregnancy
- Simple analgesic monotherapy is used in combination with caffeine for TTH patients who are unresponsive or have a poor response to analgesic monotherapy (Grdae 2A)
- It is more effective than the monotherapy but associated with more side effects
- A single dose of 2 tablets of combined acetaminophen 250mg, aspirin 250mg and caffeine 65mg can be used.
- Combination therapies including opioids or butalbital are not recommended as first line agents for TTH Rx (Grade 1C).
- They are used when NSAIDS are contraindicated
- Also used when combination analgesics with caffeine are not effective
- They are associated with multiple adverse effects such as;
- Dependency
- Tolerance
- Toxicity
- Developing medication overuse headache
- It can be prevented by limiting the acute therapy to 9days/month
- And a maximum of 2 doses per treatment day
Parenteral Therapy:
- Inpatient treatment for severe TTH can be treated in addition to the above mentioned treatment with
- Chlorpromazine
- Metoclopramide
- Combination of metoclopramide and diphenhydramine
- Intramuscular ketorolac
Triptans:
- Several studies have shown good response to Triptans in patients having TTH and migraine but the data is conflicting
- Asmall trial showed significant beneficial effect of small doses of sumatriptan in chronic TTH
- European guidelines for TTH do not recommend Triptans for TTH
Non-Pharmacological Therapy
- Acupuncture
- Biofeedback
- Cranial chiropractic
- Exercise such as swimming two to three times a week
- Heat pillow
- Massage
- Relaxation techniques like: