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How are tension-type headaches treated ?
For acute treatment, most patients respond to over-the-counter medications such as NSAIDs and simple analgesics that may be combined with caffeine. Opioids and butalbital combinations should be avoided.
Preventive treatment is indicated for those with frequent or chronic tension-type headaches. Amitriptyline (nortriptyline and protriptyline are alternatives) is started at 10 to 25 mg at bedtime and titrated to a target dose of 100 mg as tolerated.
Studies also suggest benefit from the use of mirtazapine, venlafaxine, topiramate, and gabapentin. Biofeedback and relaxation techniques may also be beneficial.
Sources
Nagy AJ, Gandhi S, Bhola R, Goadsby PJ: Intravenous dihydroergotamine for inpatient management of refractory primary headaches. Neurology 77:1827-1832, 2011.