What are the treatment options for tension headaches?
The goal of treatment is to stop the symptoms, and prevent future tension headaches by avoiding/changing your triggers. Treatment can include medications and lifestyle changes to reduce stress and anxiety. Frequent or chronic headaches that aren't relieved by over-the-counter (OTC) pain relievers may need prescription medications.
OTC pain relievers are usually the first non-prescription treatment to try. These include aspirin, ibuprofen (Advil, Motrin IB), and naproxen sodium (Aleve). They should always be taken appropriately, as your doctor prescribes them. For example, taking headache-pain medication more than three days a week can lead to rebound headaches (medication overuse headache).
Combination medications can be more effective. They include aspirin or acetaminophen (Tylenol), or both are often combined with caffeine or a sedative drug in a single medication. Taking too much acetaminophen can damage your liver; too much ibuprofen or aspirin can irritate your stomach or damage the kidneys. Also, some medications should not be taken if you’re pregnant.
Muscle relaxers can help with head, neck and shoulder tension.
Anticonvulsants, such as gabapentin and topiramate (Topamax, Qsymia), may also be prescribed to prevent headaches.
Triptans and narcotics are for people who have a migraine and tension headache at the same time. Opioids, or other narcotics are rarely used because of their side effects and potential for dependency.
Antidepressants can help prevent headaches. Amitriptyline and protriptyline are the most common medications used; venlafaxine (Effexor XR) and mirtazapine (Remeron) are also used. Antidepressant side effects can include constipation, drowsiness, and dry mouth.
Changing your triggers involves learning what your triggers are and developing ways to avoid them. A headache diary will help you identify triggers and learn what relieves the pain.
Lifestyle and home remedies have helped many patients get relief, such as rest, ice packs, or a long, hot shower. Reduce stress by planning ahead and organizing your day. Plan time to relax and de-stress everyday. Apply heat or ice to sore tight muscles. Good posture can help keep your muscles from tensing. When standing, hold your shoulders back and your head level. Pull in your abdomen and buttocks. When sitting, make sure your thighs are parallel to the ground and your head isn't slumped forward. You may want to ask your doctor about relaxation or stress-management training, deep-breathing, massage, biofeedback, cognitive behavioral therapy, or acupuncture.
Can tension headaches be prevented?
Improving your lifestyle choices can help prevent headaches, including:
- Get enough, but not too much, sleep. Try using a different or new pillow; change sleeping positions.
- Don't smoke.
- Exercise regularly.
- Take breaks during your day to stretch your neck and shoulders
- Eat regular, balanced meals.
- Drink plenty of water.
- Limit alcohol, caffeine and sugar.
- Practice good posture.
- Maintain a regular sleep, exercise, and meal schedule.
Other techniques that can help you reduce stress:
Biofeedback training teaches you to control certain body responses to reduce pain.
Cognitive behavioral therapy is talk therapy that helps you learn to manage stress, and reduce the frequency and severity of your headaches.
Any technique that relaxes you – deep breathing, yoga, meditation, prayer, progressive muscle relaxation – can help your headaches.
