Treatments and drugs

By Mayo Clinic Staff

Some people with tension headaches don't seek medical attention and try to treat the pain on their own. Unfortunately, repeated use of over-the-counter (OTC) pain relievers can actually cause overuse headaches.

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

  • Pain relievers. Simple OTC pain relievers are usually the first line of treatment for reducing headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). Prescription medications include naproxen (Naprosyn), indomethacin (Indocin) and ketorolac (Ketorolac Tromethamine).
  • Combination medications. Aspirin or acetaminophen or both are often combined with caffeine or a sedative drug in a single medication. Combination drugs may be more effective than are single-ingredient pain relievers. Many combination drugs are available OTC.
  • Triptans and narcotics. For people who experience both migraines and episodic tension headaches, a triptan can effectively relieve the pain of both headaches. Opiates, 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 nortriptyline (Pamelor), are the most commonly used medications to prevent tension headache. Side effects of these medications may include weight gain, drowsiness and dry mouth.
  • Other antidepressants. There also is some evidence to support the use of the antidepressants venlafaxine (Effexor XR) and mirtazapine (Remeron) in people who don't also have depression.
  • Anticonvulsants and muscle relaxants. Other medications that may prevent tension headache include anticonvulsants, such as topiramate (Topamax). 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 the 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.

Jul. 16, 2013

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