Treatment

Some people with tension-type headaches don't seek medical attention and try to treat the pain on their own. Unfortunately, repeated use of pain relievers that are available without a prescription can actually cause another type of headache, medication overuse headache.

Acute medications

A variety of medications, both nonprescription and prescription, are available to reduce the pain of a headache, including:

• Pain relievers. Simple pain relievers available without a prescription 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).
• Combination medications. Aspirin or acetaminophen (Tylenol, others) or both are often combined with caffeine or a sedative drug in a single medication. Combination drugs may be more effective than single-ingredient pain relievers. Many combination drugs are available without a prescription.
• Triptans and narcotics. For people who experience both migraines and episodic tension-type headaches, a triptan can effectively relieve the pain of both headaches. Opioids, or narcotics, are rarely used because of their side effects and potential for dependency.

Preventive medications

Your doctor may prescribe medications to reduce the frequency and severity of attacks, especially if you have frequent or chronic headaches that aren't relieved by pain medication and other therapies.

Preventive medications may include:

• Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and protriptyline, are the most commonly used medications to prevent tension-type headaches. Side effects of these medications may include constipation, drowsiness and dry mouth.
• Other antidepressants. Evidence also supports the use of the antidepressants venlafaxine (Effexor XR) and mirtazapine (Remeron).
• Anticonvulsants and muscle relaxants. Other medications that may prevent tension-type headaches include anticonvulsants, such as gabapentin and topiramate (Topamax, Qsymia, others). More study is needed.

Preventive medications may require several weeks or more to build up in your system before they take effect. So don't get frustrated if you haven't seen improvements shortly after you begin taking a drug.

Your doctor will monitor your treatment to see how the preventive medication is working. In the meantime, overuse of pain relievers for your headaches may interfere with the effects of the preventive drugs. Ask your doctor about how often to use pain relievers while you’re taking preventive medication.