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How are tension headaches treated?

Tension headaches are painful, and patients may be upset that the diagnosis is "only" a tension headache. Even though it is not life-threatening, a tension headache can make daily activities more difficult to accomplish. Most people successfully treat themselves with over-the�counter (OTC) pain medications to control tension headaches. The following work well for most people:

  • aspirin,
  • ibuprofen (Motrin, Advil),
  • acetaminophen (Tylenol, Panadol) and
  • naproxen (Aleve).

If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Physical therapy, massage, biofeedback, and stress management can all be used as adjuncts to help with control of tension headaches.

It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It always is wise to ask a health-care professional or pharmacist if one has questions about OTC medications and their use. This is especially important with OTC pain medications, because they are used so frequently.

It is important to read the listing of ingredients in OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third listed ingredient may have the potential for drug interaction or contraindication based upon a patient's other medical issues For example:

  • Some OTC medications include caffeine, which may trigger rapid heartbeats in some patients.
  • In night time preparations, diphenhydramine (Benadryl) may be added. This may cause sedation, and driving or using heavy machinery may not be appropriate when taking a sedative medication.
  • Some OTC cold medications have pseudoephedrine mixed in with the pain medication. This drug can cause elevated blood pressure and palpitations.

Other examples where caution should be used include the following:

  • Aspirin should not be used in children and teenagers because of the risk of Reye's Syndrome, a life threatening complication that may occur when a viral infection is present and aspirin is taken.
  • Aspirin, ibuprofen, and naproxen are anti-inflammatory medications that can be irritating to the stomach and may cause intestinal bleeding. They should be used with caution in patients who have peptic ulcer disease.
  • Most anti-inflammatory medicines also cause the potential for bleeding elsewhere in the body and should not be taken by patients who also take blood thinners without discussing the risks and benefits with their health-care professional. Blood thinners include warfarin (Coumadin), heparin (Lovenox), dabigatran (Pradaxa), apixaban (Eliquis), rivoroxaban (Xarelto), edoxaban (Savaysa), clopidogrel bisulfate (Plavix), ticagrelor (Brilinta), and prasugrel (Effient).
  • Overuse of aspirin, ibuprofen, and naproxen also may cause kidney damage.
  • Acetaminophen, if used in amounts greater than recommended, can cause liver damage or failure. It also should be used with caution in patients who drink significant amounts of alcohol or who have liver disease because even lesser doses than are normally recommended may be dangerous.
  • Medication overuse headache can be mistaken for chronic tension headaches. When pain medications are used for a prolonged period of time, headaches may recur because the effects of the medication wear off. (This type of headache was referred to as a "rebound headache," and is classified as a secondary headache.)
Return to Headache

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