Treatment of Chronic Tension-Type Headaches

In general, analgesic medications, such as aspirin, acetaminophen (Tylenol®), or ibuprofen (Advil®), are poor choices for treating chronic tension-type headaches (CTTH).

• In fact, these medications may lead to rebound, or analgesic-abuse, headaches.
• For particularly painful headache flareups, several analgesic doses per week may be appropriately used to provide welcome pain relief.

The main therapy for CTTH is preventive medications.

• The most rigorously demonstrated effective treatment for CTTH is amitriptyline (Elavil®), a tricyclic antidepressant (TCA). In most patients, amitriptyline decreases headache pain but does not usually eliminate it completely. Patients taking preventive amitriptyline tend to have fewer days with headaches and decreased pain intensity during headache attacks.
• Another TCA, nortriptyline (Pamelor®), and a mild antianxiety medication, buspirone (BuSpar®), both appear to be effective for treating CTTH.
• Fluoxetine (Prozac®) and other selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed for CTTH by physicians, but clinical studies do not support the effectiveness of SSRIs for alleviating headache pain.

Treatment of ETTH

Medications