Tension headache treatments

Tension headache is the most common type of headache, and can be triggered by a lack of sleep, stress, dehydration, skipping meals and poor posture. Most of us have experienced a tension headache, which often feels like a tight band of pressure around the head. Treatment involves treating the pain and reducing stress and tension.

Painkillers for tension headaches

There are several pain relievers available in Australia for the treatment of tension headaches. For best effect, painkillers should be given when your headache first comes on.

Painkillers that are available include:

  • paracetamol;
  • aspirin; and
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ibuprofen and naproxen.

Some of these medicines are available over-the-counter in in pharmacies and supermarkets, while others are only available on prescription.

There are also combination medicines available that can help relieve a tension headache. These medicines contain paracetamol plus either ibuprofen or caffeine.

Paracetamol plus caffeine may be useful if your headache has not responded to other treatments. However, it should not be used frequently as it can lead to medication overuse headaches (see below).

Risks and side effects associated with painkillers

Paracetamol is associated with few side effects, but if too much is taken it can cause serious liver damage.

Regular use of NSAIDs, including aspirin, increases your risk of developing a peptic ulcer in the stomach. Aspirin and NSAIDs can also irritate the stomach, causing heartburn, nausea and vomiting. Use of NSAIDs is associated with a small increased risk of having a heart attack or stroke. Allergic reactions are also possible.

Aspirin should not be used in children aged 16 years or younger, except under medical advice.

NSAIDs and aspirin should be avoided by people who have a history of asthma symptoms being triggered by these medicines, those with kidney problems and pregnant or breast feeding women.

Medication overuse headaches

If you take painkillers for headaches too often, it can lead to medication overuse headaches. These headaches are very frequent or chronic (ongoing), and don’t respond to painkillers.

Medication overuse headaches can develop if you’ve been taking painkillers every day or every other day for an extended period of time. The risk is higher if you take pain relievers combined with caffeine.

If you feel like you need painkillers more often than 2 days per week for tension headaches, or are worried you may have developed medication overuse headaches, see your doctor.

Medicines to prevent tension headaches

Treatment to prevent tension headaches may be recommended for people with frequent or chronic tension headaches.

Tricyclic antidepressant medicines (such as amitriptyline or nortriptyline) can be used to help prevent tension headaches. Low doses of tricyclic antidepressants can be trialled for 8 weeks, and if effective, your doctor may recommend 6 months’ treatment with these medicines.

Possible side effects associated with amitriptyline include dry mouth, nausea, dizziness and drowsiness.

Reducing stress and tension

Anything that reduces stress and tension can help relieve and prevent tension headaches.

  • Massage can relieve tension in the muscles of the back of the head, neck and shoulders and relieve headache pain for some people.
  • Heat can also help treat tension headache – try taking a hot shower or using a heat pack.
  • Correcting poor posture can help by relieving muscle tension.
  • Biofeedback – the use of electronic devices to teach people how to regulate body functions and responses, such as muscle tension – may help reduce pain.
  • Cognitive behavioural therapy (CBT), a type of therapy that involves identifying and challenging negative thinking patterns and developing alternative ways of thinking and acting, can help reduce stress. CBT can be used to treat tension headaches that are constant or frequently recurring.
  • Relaxation exercises (including deep breathing or progressive muscle relaxation) and stress management training can help prevent tension headaches. Practising mindfulness or yoga may also reduce stress and tension.

Physiotherapists can provide massage and heat treatments as well as advice on posture correction. Your physio may also stretch your neck muscles and suggest specific exercises that may help.

Psychologists, therapists and some GPs (general practitioners) can offer treatment with cognitive behavioural therapy and relaxation therapy.

People with depression and anxiety seem to get more tension headaches than people without these conditions. If you think your headaches may be related to something more than stress, see your doctor.

Complementary therapies for headaches

Many people who get regular tension headaches turn to complementary therapies for relief. And there are some complementary therapies that have been shown to be helpful in the treatment of tension headaches. But it’s important to remember that not all complementary therapies have proven benefits, and like other medicines, these treatments have side effects. Some are not suitable during pregnancy or for people with medical conditions.

It’s always best to tell your doctor if you are using or planning on using a complementary therapy. They can advise you on whether the treatment is safe for you and can be used together with other treatments. They may also be able to recommend a practitioner (for example, an acupuncturist).

Acupuncture for tension headache

There is some evidence that acupuncture can be effective in the treatment of tension headaches. A minimum of 6 sessions is generally needed to get a noticeable benefit. Acupuncture can also help prevent tension headaches in people who suffer from frequent headaches.

Acupuncture is generally considered safe when performed by qualified practitioners using sterile needles. Side effects are uncommon.

Supplements

Supplements that may help with headaches include riboflavin and coenzyme Q10. However, these supplements are generally recommended for migraine prevention rather than treatment of tension headaches. It’s also important to remember that these supplements are associated with side effects and can interact with other medicines.

Tai chi

Tai chi (which is a combination of meditation, controlled breathing, relaxation and slow, graceful movements) may be helpful in treating tension headaches. Tai chi is generally considered safe, but more evidence is needed to show its effectiveness as a headache treatment.

Preventing tension headaches

There are some simple things you can do to help prevent tension headaches, including:

  • making sure you drink plenty of fluids;
  • eating regular meals;
  • getting adequate sleep;
  • reducing your caffeine intake; and
  • getting regular exercise.

If you work at a computer all day, it can help to set up your desk ergonomically. Take regular, short breaks when you are at work, using the time to stretch and rest your eyes.

If you have frequent tension headaches, your doctor may suggest keeping a headache diary. This involves keeping a record of when you have headaches and what activities you were doing around the time you got them. A headache diary can help you work out if there is a pattern to your headaches or if anything is triggering them.

References

1. Tension-type headache (published November 2017). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2019 Jan. https://tgldcdp.tg.org.au/ (accessed Feb 2019).
2. BMJ Best Practice. Tension-type headache (updated Jul 2018; reviewed Jan 2019). https://bestpractice.bmj.com (accessed Feb 2019).
3. NPS Medicinewise. Headaches and how to treat them (published 19 Apr 2017). https://www.nps.org.au/medical-info/consumer-info/headaches-and-how-to-treat-them (accessed Feb 2019).
3. National Centre for Complementary and Integrative Health. Headaches: in depth (updated Sep 2016). https://nccih.nih.gov/health/pain/headachefacts.htm (accessed Feb 2019).
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