How To Treat Tension Headaches

Most people do not see their healthcare provider for a tension headache. That rubber-band-around-the-head sensation is common and usually treated with simple measures like sleep, water, or an over-the-counter (OTC) medication.

Let's take a closer look at medical therapies for tension headaches, including one class of medications that may be prescribed by your healthcare provider to help prevent these nagging headaches.

Over-the-Counter Medications

A number of nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful for treating a tension headache. The most common include:

• Advil (ibuprofen)
• Aleve (naproxen sodium)
• Aspirin
• Toradol (ketorolac)
• Voltaren (diclofenac potassium)

Some, like Toradol and Voltaren, are available both over-the-counter (in some countries) and in stronger prescription-strength formulations. NSAIDs can cause side effects and should be avoided by people with a history of peptic ulcers, kidney disease, uncontrolled hypertension, inflammatory bowel disease (IBD), stroke, or transient ischemic attack (TIA).

Tylenol (acetaminophen) can also alleviate a tension headache and may be able to do so without the side effects of NSAIDs.

Alternative Therapies

Drugs are not the only means to control tension headaches. Alternative therapies may provide relief by addressing the underlying cause of headaches, both physical and psychological. Examples include:

• Physical therapy
• Relaxation therapy
• Self-hypnosis
• Biofeedback
• Cognitive-behavioral therapy (CBT)

The goal of physical therapy is to improve posture and provide muscle relaxation through the use of hot and cold packs, ultrasound, massage, and home exercise. A 2014 review of studies from Spain concluded that manual physical therapy combined with cervical (neck) stretching and massage was the most effective means of relieving chronic tension headaches.

Relaxation, biofeedback, self-hypnosis, and CBT are psychological therapies. In biofeedback, people are taught to control muscle tension by monitoring the electrical activity of face, neck, or shoulders muscles on a digital or audio display. In CBT, people are trained to reduce stressful thoughts that trigger or irritate tension headaches.

Prevention

Preventing tension headaches is as important—and some argue more important—than treating them. In people with severe chronic tension headaches, healthcare providers may explore prescription medications called tricyclic antidepressants that are used prophylactically (on an ongoing basis to prevent illness) if other conservative therapies fail.

One of the best options is Elavil (amitriptyline), a tricyclic antidepressant that has been shown to reduce the number of tension headache days compared to a placebo. The effects tend to increase the longer the tricyclic antidepressant is used. Even if headaches do occur, they are generally 50% less intense than they were before treatment.

It is not entirely clear what the effective dose is. Based on the current body of research, the daily dose for Elavil ranges from 10 milligrams (mg) per day to 150 mg per day. As a general rule, it is best to start with the lowest possible dose and increase gradually as tolerated.

Common side effects of Elavil include dry mouth, weight gain, and sleepiness. Other potentially serious side effects include abnormal heart rhythms, difficulty urinating, and glaucoma.

Other tricyclic antidepressant options include Anafranil (clomipramine), Norpramin (desipramine), opipramol, doxepin, and amitriptylinoxide.

A Word From Verywell

One of the risks of self-treating tension headaches is the inappropriate use or overuse of headache medications. This can lead to medication overuse headaches (MOH) in which the body becomes "immune" to the effects of analgesic (pain-relieving) drugs and triggers a rebound of daily headache symptoms.

Always speak with your healthcare provider first before taking any medication to treat chronic tension headaches. It is also important to speak with your healthcare provider if your headaches feel different or are becoming more frequent.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed healthcare provider. Please see your healthcare provider for diagnosis and treatment of any concerning symptoms or medical condition.