Materiały źródłowe

• #1 Tension Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/8257-tension-headaches

  Managing stress may be the most effective way to prevent a tension headache. The most effective stress management tools are the ones that you can fit into your daily routine and make you feel good. Some examples include: […] Regular exercise. […] Getting enough rest.

• #2 Drug and Nondrug Treatment in Tension-type Headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002628/

  Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Nondrug management is crucial. Information, reassurance and identification of trigger factors may be rewarding. Psychological treatments with scientific evidence for efficacy include relaxation training, EMG biofeedback and cognitive-behavioural therapy. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. The development of specific nonpharmacological and pharmacological managements for TTH with higher efficacy and fewer side effects is urgently needed. Prophylactic pharmacotherapy should be considered in patients with headaches on more than 15 days per month; that is, in patients with chronic TTH. The tricyclic antidepressant amitriptyline is the only drug that has proven to be effective in several controlled trials in TTH. It is important that patients are informed that this is an antidepressant agent but has an independent action on pain. In general, the initial approach to prophylactic pharmacotherapy of chronic TTH is through the use of amitriptyline. More efficient prophylactic drugs with fewer side effects are urgently needed for the preventive treatment of TTH. […] As neither nonpharmacological nor pharmacological management is highly efficient it is usually recommended to combine multiple strategies, although proper evidence is lacking.

• #3 Tension Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/8257-tension-headaches

  Managing stress may be the most effective way to prevent a tension headache. The most effective stress management tools are the ones that you can fit into your daily routine and make you feel good. Some examples include: […] Regular exercise. […] Getting enough rest.

• #4 Tension-type headaches: Self-care measures for relief

  https://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20047631

  Headaches can interfere with daily life. But healthy lifestyle choices can help you head off the pain. Start with diet, exercise and relaxation. […] Medicines may relieve the pain. But simply taking good care of yourself may help prevent a headache. […] A healthy lifestyle can promote good overall health. It also may help prevent all types of headaches, including tension-type headaches. […] Eat nutritious foods on a regular schedule. Don’t skip meals, especially breakfast. Drink plenty of water each day. […] Exercise regularly. Exercise releases chemicals in the body that block pain signals to the brain. […] Get enough sleep. Wake up and go to bed at the same time every day even on weekends. […] Avoid large amounts of caffeine. Caffeine may help curb headaches. But heavy daily caffeine use can lead to headaches.

• #5 Tension-type headaches: Self-care measures for relief

  https://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20047631

  Headaches can interfere with daily life. But healthy lifestyle choices can help you head off the pain. Start with diet, exercise and relaxation. […] Medicines may relieve the pain. But simply taking good care of yourself may help prevent a headache. […] A healthy lifestyle can promote good overall health. It also may help prevent all types of headaches, including tension-type headaches. […] Eat nutritious foods on a regular schedule. Don’t skip meals, especially breakfast. Drink plenty of water each day. […] Exercise regularly. Exercise releases chemicals in the body that block pain signals to the brain. […] Get enough sleep. Wake up and go to bed at the same time every day even on weekends. […] Avoid large amounts of caffeine. Caffeine may help curb headaches. But heavy daily caffeine use can lead to headaches.

• #6 Headache prevention – Catch it before it starts | Evergreen Life

  https://www.evergreen-life.co.uk/health-wellbeing-library/headache-prevention/

  Eat regular healthy meals A study suggests that missing meals are linked with headaches. […] Be caffeine conscious Despite some headache medications containing caffeine as it can reduce headache pain, caffeine overload may lead to rare migraine episodes becoming more of an ongoing issue (chronic). […] Hone your hydration Headaches can stem from dehydration, though often being dehydrated can worsen underlying medical conditions like the primary headaches discussed above. […] Minimise stress This isn’t always as hard as it sometimes first appears and may alleviate headaches. […] Embrace regular exercise With so many benefits, including headache prevention, frequent aerobic activities like walking, swimming or cycling can boost your physical and mental wellbeing and reduce stress. […] Explore cognitive behavioural therapy (CBT), should you live with tension headaches. CBT has been cited as a type of talking therapy that may equip you with skills to manage stress and aid in minimising the frequency and severity of your headaches.

• #7 Understanding Headache Causes, Treatment & Prevention | TYLENOL®

  https://www.tylenol.com/adult-relief/headaches/causes-treatment-prevention

  One of the simplest and most effective ways to manage and prevent headaches is to stay hydrated. […] Since tension-type headaches and cluster headaches are often accompanied by dehydration, simply drinking water with electrolytes may provide tension headache relief at home. […] Regular physical activity is a great way to manage stress exercise releases endorphins, which are natural painkillers, and also improves mood and reduces tension. […] On top of staying active, consider adding relaxation practices like yoga and meditation to your routine. […] Adequate sleep is a powerful (and free) tool to use when you’re wondering how to prevent headaches. […] One of the most practical ways to reduce frequency and severity of headaches is to establish a consistent sleep schedule. […] Over-the-counter (OTC) pain medications like TYLENOL Extra Strength Caplets and Extra Strength TYLENOL Rapid Release Gels can be a good step in managing headache pain.

• #8 Top 4 Tips for Tension Headache Prevention

  https://www.macspharmacy.com/blog/tips-tension-headache-prevention/

  You have probably experienced tension headaches from time to time, which are often referred to as stress headaches. […] The good news is that there are several things you can do to prevent them! Here are the top 4 tips for tension headache prevention: […] The best thing that you can do to prevent a tension headache is to stay hydrated! […] Another tip for preventing tension headaches is to exercise on a regular basis, ideally at least 30 minutes 5 times per week. […] While it may sound easier said than done, you can limit your tension headaches simply by reducing the amount of stress in your life! […] One of the many benefits of a good night of sleep is that it makes it easier to deal with daily stress, which in turn reduces your risk for a tension headache.

• #9 Tension-type headaches: Self-care measures for relief

  https://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20047631

  Headaches can interfere with daily life. But healthy lifestyle choices can help you head off the pain. Start with diet, exercise and relaxation. […] Medicines may relieve the pain. But simply taking good care of yourself may help prevent a headache. […] A healthy lifestyle can promote good overall health. It also may help prevent all types of headaches, including tension-type headaches. […] Eat nutritious foods on a regular schedule. Don’t skip meals, especially breakfast. Drink plenty of water each day. […] Exercise regularly. Exercise releases chemicals in the body that block pain signals to the brain. […] Get enough sleep. Wake up and go to bed at the same time every day even on weekends. […] Avoid large amounts of caffeine. Caffeine may help curb headaches. But heavy daily caffeine use can lead to headaches.

• #10 Headache prevention – Catch it before it starts | Evergreen Life

  https://www.evergreen-life.co.uk/health-wellbeing-library/headache-prevention/

  Eat regular healthy meals A study suggests that missing meals are linked with headaches. […] Be caffeine conscious Despite some headache medications containing caffeine as it can reduce headache pain, caffeine overload may lead to rare migraine episodes becoming more of an ongoing issue (chronic). […] Hone your hydration Headaches can stem from dehydration, though often being dehydrated can worsen underlying medical conditions like the primary headaches discussed above. […] Minimise stress This isn’t always as hard as it sometimes first appears and may alleviate headaches. […] Embrace regular exercise With so many benefits, including headache prevention, frequent aerobic activities like walking, swimming or cycling can boost your physical and mental wellbeing and reduce stress. […] Explore cognitive behavioural therapy (CBT), should you live with tension headaches. CBT has been cited as a type of talking therapy that may equip you with skills to manage stress and aid in minimising the frequency and severity of your headaches.

• #11 Tension-type headaches: Self-care measures for relief

  https://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20047631

  Headaches can interfere with daily life. But healthy lifestyle choices can help you head off the pain. Start with diet, exercise and relaxation. […] Medicines may relieve the pain. But simply taking good care of yourself may help prevent a headache. […] A healthy lifestyle can promote good overall health. It also may help prevent all types of headaches, including tension-type headaches. […] Eat nutritious foods on a regular schedule. Don’t skip meals, especially breakfast. Drink plenty of water each day. […] Exercise regularly. Exercise releases chemicals in the body that block pain signals to the brain. […] Get enough sleep. Wake up and go to bed at the same time every day even on weekends. […] Avoid large amounts of caffeine. Caffeine may help curb headaches. But heavy daily caffeine use can lead to headaches.

• #12 Understanding Headache Causes, Treatment & Prevention | TYLENOL®

  https://www.tylenol.com/adult-relief/headaches/causes-treatment-prevention

  One of the simplest and most effective ways to manage and prevent headaches is to stay hydrated. […] Since tension-type headaches and cluster headaches are often accompanied by dehydration, simply drinking water with electrolytes may provide tension headache relief at home. […] Regular physical activity is a great way to manage stress exercise releases endorphins, which are natural painkillers, and also improves mood and reduces tension. […] On top of staying active, consider adding relaxation practices like yoga and meditation to your routine. […] Adequate sleep is a powerful (and free) tool to use when you’re wondering how to prevent headaches. […] One of the most practical ways to reduce frequency and severity of headaches is to establish a consistent sleep schedule. […] Over-the-counter (OTC) pain medications like TYLENOL Extra Strength Caplets and Extra Strength TYLENOL Rapid Release Gels can be a good step in managing headache pain.

• #13 Tension-type headaches: Self-care measures for relief

  https://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20047631

  Headaches can interfere with daily life. But healthy lifestyle choices can help you head off the pain. Start with diet, exercise and relaxation. […] Medicines may relieve the pain. But simply taking good care of yourself may help prevent a headache. […] A healthy lifestyle can promote good overall health. It also may help prevent all types of headaches, including tension-type headaches. […] Eat nutritious foods on a regular schedule. Don’t skip meals, especially breakfast. Drink plenty of water each day. […] Exercise regularly. Exercise releases chemicals in the body that block pain signals to the brain. […] Get enough sleep. Wake up and go to bed at the same time every day even on weekends. […] Avoid large amounts of caffeine. Caffeine may help curb headaches. But heavy daily caffeine use can lead to headaches.

• #14 Tension headaches

  https://www.nhs.uk/conditions/tension-headaches/

  If you get tension headaches regularly, you may be offered a course of acupuncture. […] An antidepressant medicine called amitriptyline is also sometimes recommended to help prevent tension headaches. […] You’ll be prescribed a low-dose to start with, which may later be increased. The medicine usually needs to be taken for several months before it starts working.

• #15 Tension-type headaches: Self-care measures for relief

  https://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20047631

  Be mindful of common pain medicines. You can buy pain medicine at the store. But using this medicine more than nine days a month can make headaches harder to treat. […] Quit smoking. The nicotine in cigarette smoke reduces blood flow to the brain. It also triggers a reaction in the nerves at the back of the throat. These changes can lead to a headache. […] Stress and tension-type headaches often go hand in hand. To reduce stress, try these simple tips: […] A diary may help you learn what triggers your tension-type headaches. Note when your headaches start and your activities. Also record how long the headaches last and anything that provides relief. The diary may help you spot patterns in your daily habits that may lead to headaches. […] Look for improvements in your headaches as you make additional healthy lifestyle changes.

• #16 Tension-Type Headache | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0901/p797.html

  Amitriptyline is the most widely researched prophylactic agent for frequent headaches. […] A wide variety of prophylactic agents have been researched in the management of chronic tension-type headache, and comprehensive reviews are available for interested readers. […] Amitriptyline (Elavil) is the most researched of the prophylactic agents for chronic tension-type headache. It is typically used in doses of 10 to 75 mg, one to two hours before bedtime to minimize grogginess on awakening. Double-blind randomized controlled studies confirm its use in patients with chronic tension-type headache. […] Selective serotonin reuptake inhibitors (SSRIs) cause fewer side effects, and several of these agents (paroxetine [Paxil], venlafaxine [Effexor], and fluoxetine [Prozac]) have shown their efficacy in the prophylaxis of chronic tension-type headache in small studies. […] Smoking cessation is an important issue to address in patients with chronic tension-type headache. The number of cigarettes smoked has been significantly related to the headache index score and to the number of days with headache each week.

• #17

  https://myhealth.alberta.ca/Health/medications/Pages/conditions.aspx?hwid=not46139&lang=en-ca

  Good posture and good body mechanics can help prevent tension in your neck, shoulders, and upper back muscles. If your headaches seem to be related to tension in this area, maintaining good posture during daily activities may help prevent headaches. […] Use good body mechanics all the time, not just when you have a headache or back pain. Here are some things you can do. […] Avoid exercises that require you to hyperextend your neck.

• #18 Tension headache Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/tension-headache

  Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve the effect of doing relaxation exercises, and may be helpful for long-term (chronic) tension headache. […] Tips to prevent tension headaches: […] Keep warm if the headache is associated with cold. […] Use a different pillow or change sleeping positions. […] Practice good posture when reading, working, or doing other activities. […] Exercise the neck and shoulders frequently when working on computers or doing other close work. […] Get plenty of sleep and rest. […] Massaging sore muscles may also help.

• #19 Tension headache Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/tension-headache

  Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve the effect of doing relaxation exercises, and may be helpful for long-term (chronic) tension headache. […] Tips to prevent tension headaches: […] Keep warm if the headache is associated with cold. […] Use a different pillow or change sleeping positions. […] Practice good posture when reading, working, or doing other activities. […] Exercise the neck and shoulders frequently when working on computers or doing other close work. […] Get plenty of sleep and rest. […] Massaging sore muscles may also help.

• #20 Tension headache Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/tension-headache

  Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve the effect of doing relaxation exercises, and may be helpful for long-term (chronic) tension headache. […] Tips to prevent tension headaches: […] Keep warm if the headache is associated with cold. […] Use a different pillow or change sleeping positions. […] Practice good posture when reading, working, or doing other activities. […] Exercise the neck and shoulders frequently when working on computers or doing other close work. […] Get plenty of sleep and rest. […] Massaging sore muscles may also help.

• #21 How To Get Rid Of A Tension Headache | Arizona Pain

  https://arizonapain.com/how-to-get-rid-of-a-tension-headache/

  To remedy any muscle imbalance, as discussed previously, one option is to strengthen the core muscles that support the entire body. Adding that core strength can be trendy, but it works. […] To improve overall posture, try to keep any electronic devices like phones or tablets at eye level so the back and neck stay at a healthy, natural position. Computer monitors should also be kept at eye level. Try to take regular breaks and stretch the neck and shoulders to break up any accumulating muscle tension. […] Over-the-counter medication such as ibuprofen and acetaminophen can be a very effective and simple route for how to get rid of a tension headache. As long as taken as directed, it can be a fantastic tool when used in combination with other techniques.

• #22 Headache Prevention: Posture and Body Mechanics Information

  https://www.columbiadoctors.org/health-library/article/headache-prevention-posture-body-mechanics/

  Good posture and good body mechanics can help prevent tension in your neck, shoulders, and upper back muscles. If your headaches seem to be related to tension in this area, maintaining good posture during daily activities may help prevent headaches. […] Use good body mechanics all the time, not just when you have a headache or back pain. Here are some things you can do. […] Take breaks once an hour to stretch your neck and back muscles. […] Use proper lifting techniques. Lift with your legs, not your back. […] Avoid exercises that require you to hyperextend your neck.

• #23 Tension headache Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/tension-headache

  Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve the effect of doing relaxation exercises, and may be helpful for long-term (chronic) tension headache. […] Tips to prevent tension headaches: […] Keep warm if the headache is associated with cold. […] Use a different pillow or change sleeping positions. […] Practice good posture when reading, working, or doing other activities. […] Exercise the neck and shoulders frequently when working on computers or doing other close work. […] Get plenty of sleep and rest. […] Massaging sore muscles may also help.

• #24 Tension-Type Headache: Symptoms, Types and Treatments

  https://americanmigrainefoundation.org/resource-library/tension-type-headache/

  In addition to inadequate sleep and poor posture, stress is the most frequently reported trigger for tension-type headache. […] Regular exercise and relaxation techniques can help reduce the frequency of tension-type headache, but over-the-counter medications may also be necessary if headache pain is especially frequent or long-lasting. […] If tension-type headaches are frequent, long-lasting or create significant disability, then preventive treatment may be recommended. Commonly used preventive strategies include medications like amitriptyline and non-medication headache treatments such as biofeedback, relaxation, cognitive-behavioral therapy, acupuncture, massage therapy or physical therapy. Patients should always consult their doctor first before trying any new preventive strategies. […] More frequent tension-type headaches may require daily preventive medications or complementary therapies to restore health and quality of life.

• #25 How to Relieve Tension Headache Pain and Reduce Triggers

  https://www.baystatehealth.org/articles/tension-headache-relief

  Our expert shares tactics below for immediate relief – like ice or self-massage – and for long-term prevention of tension headaches – like restful sleep or mindfulness training. […] […] For Long-Term Prevention: […] Sufficient restful sleep: attempt to achieve deep sleep without disruptions as this signals the muscles to relax. Develop your sleep hygiene routine for better sleep. […] Structured massage therapy or deep tissue massage: works to relax strained muscles that may be the root cause of headache pain. […] Mindfulness training: teaches you how to quiet your mind so that you can get a more restful sleep. […] Cognitive behavioral therapy: helps you recognize stress triggers and how you respond to them, helping to relieve anxiety. […] Exercise and meditation: relieve muscle tension.

• #26 Tension Headache Treatment & Management: Medical Care, Alternative Medicine

  https://emedicine.medscape.com/article/792384-treatment

  Various modalities are used in the treatment of tension headaches. These include hot or cold packs, ultrasound, electrical stimulation, improvement of posture, trigger point injections, occipital nerve blocks, stretching, and relaxation techniques. […] Regular exercise, stretching, balanced meals, and adequate sleep may be part of a headache treatment program. […] Non-pharmacological treatments for headache include behavioral treatments such as cognitive-behavioral therapy, relaxation, and biofeedback, as well as acupuncture and massage. These treatments are options for patients who prefer non-pharmacological treatments or cannot take medications such as pregnant patients. […] Relaxation techniques such as meditation are effective for chronic headaches as measured by headache parameters. Patients with chronic headaches have been showed to have low levels of cortisol that normalized with the practice of meditation over time.

• #27 4 ways to tame tension headaches – Harvard Health

  https://www.health.harvard.edu/pain/4-ways-to-tame-tension-headaches

  If you are prone to tension headaches, here are four strategies that can show you how to get rid of a headache: […] Get enough sleep, don’t skip meals, and be sure to pace yourself to avoid stress and fatigue. […] Physical and psychological relaxation therapies can help stave off tension headaches, so long as you practice these techniques regularly. […] This relaxation technique requires special training but can help people avoid recurrent tension headaches. […] There are also a number of medications that can help keep tension headaches at bay.

• #28 Drug and Nondrug Treatment in Tension-type Headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002628/

  Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Nondrug management is crucial. Information, reassurance and identification of trigger factors may be rewarding. Psychological treatments with scientific evidence for efficacy include relaxation training, EMG biofeedback and cognitive-behavioural therapy. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. The development of specific nonpharmacological and pharmacological managements for TTH with higher efficacy and fewer side effects is urgently needed. Prophylactic pharmacotherapy should be considered in patients with headaches on more than 15 days per month; that is, in patients with chronic TTH. The tricyclic antidepressant amitriptyline is the only drug that has proven to be effective in several controlled trials in TTH. It is important that patients are informed that this is an antidepressant agent but has an independent action on pain. In general, the initial approach to prophylactic pharmacotherapy of chronic TTH is through the use of amitriptyline. More efficient prophylactic drugs with fewer side effects are urgently needed for the preventive treatment of TTH. […] As neither nonpharmacological nor pharmacological management is highly efficient it is usually recommended to combine multiple strategies, although proper evidence is lacking.

• #29 How to Relieve Tension Headache Pain and Reduce Triggers

  https://www.baystatehealth.org/articles/tension-headache-relief

  Our expert shares tactics below for immediate relief – like ice or self-massage – and for long-term prevention of tension headaches – like restful sleep or mindfulness training. […] […] For Long-Term Prevention: […] Sufficient restful sleep: attempt to achieve deep sleep without disruptions as this signals the muscles to relax. Develop your sleep hygiene routine for better sleep. […] Structured massage therapy or deep tissue massage: works to relax strained muscles that may be the root cause of headache pain. […] Mindfulness training: teaches you how to quiet your mind so that you can get a more restful sleep. […] Cognitive behavioral therapy: helps you recognize stress triggers and how you respond to them, helping to relieve anxiety. […] Exercise and meditation: relieve muscle tension.

• #30 Headache prevention – Catch it before it starts | Evergreen Life

  https://www.evergreen-life.co.uk/health-wellbeing-library/headache-prevention/

  Eat regular healthy meals A study suggests that missing meals are linked with headaches. […] Be caffeine conscious Despite some headache medications containing caffeine as it can reduce headache pain, caffeine overload may lead to rare migraine episodes becoming more of an ongoing issue (chronic). […] Hone your hydration Headaches can stem from dehydration, though often being dehydrated can worsen underlying medical conditions like the primary headaches discussed above. […] Minimise stress This isn’t always as hard as it sometimes first appears and may alleviate headaches. […] Embrace regular exercise With so many benefits, including headache prevention, frequent aerobic activities like walking, swimming or cycling can boost your physical and mental wellbeing and reduce stress. […] Explore cognitive behavioural therapy (CBT), should you live with tension headaches. CBT has been cited as a type of talking therapy that may equip you with skills to manage stress and aid in minimising the frequency and severity of your headaches.

• #31 Tension headache Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/tension-headache

  Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve the effect of doing relaxation exercises, and may be helpful for long-term (chronic) tension headache. […] Tips to prevent tension headaches: […] Keep warm if the headache is associated with cold. […] Use a different pillow or change sleeping positions. […] Practice good posture when reading, working, or doing other activities. […] Exercise the neck and shoulders frequently when working on computers or doing other close work. […] Get plenty of sleep and rest. […] Massaging sore muscles may also help.

• #32 Tension Headache Treatment & Management: Medical Care, Alternative Medicine

  https://emedicine.medscape.com/article/792384-treatment

  Acupuncture may be helpful for patients experiencing frequent or chronic TTH. A review of eleven studies involving 2,317 patients found evidence to support acupuncture as a valuable, nonpharmacologic tool for episodic or chronic TTH. […] According to several studies, massage may also be an effective therapy for individuals suffering from TTH. Massage can relieve tight muscles in the back of the head, neck, and shoulders, which may in turn relieve headache pain. […] A combination of therapy with stress re-education and biofeedback may be best for patients.

• #33 Tension Headache Treatment & Management: Medical Care, Alternative Medicine

  https://emedicine.medscape.com/article/792384-treatment

  Acupuncture may be helpful for patients experiencing frequent or chronic TTH. A review of eleven studies involving 2,317 patients found evidence to support acupuncture as a valuable, nonpharmacologic tool for episodic or chronic TTH. […] According to several studies, massage may also be an effective therapy for individuals suffering from TTH. Massage can relieve tight muscles in the back of the head, neck, and shoulders, which may in turn relieve headache pain. […] A combination of therapy with stress re-education and biofeedback may be best for patients.

• #34

  https://link.springer.com/article/10.1007/s00415-023-11695-1

  Acupuncture has been shown to reduce tension-type headache (TTH) frequency in previous studies. […] Acupuncture is an efficacious and safe treatment for TTH prevention, but this conclusion might be limited by the generally very low to low quality evidence. […] TSA suggested that high-quality trials are needed to verify the efficacy and safety of acupuncture compared to sham acupuncture.

• #35 Tension-type headaches: Self-care measures for relief

  https://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20047631

  Be mindful of common pain medicines. You can buy pain medicine at the store. But using this medicine more than nine days a month can make headaches harder to treat. […] Quit smoking. The nicotine in cigarette smoke reduces blood flow to the brain. It also triggers a reaction in the nerves at the back of the throat. These changes can lead to a headache. […] Stress and tension-type headaches often go hand in hand. To reduce stress, try these simple tips: […] A diary may help you learn what triggers your tension-type headaches. Note when your headaches start and your activities. Also record how long the headaches last and anything that provides relief. The diary may help you spot patterns in your daily habits that may lead to headaches. […] Look for improvements in your headaches as you make additional healthy lifestyle changes.

• #36 Headache Prevention Techniques | Excedrin

  https://www.excedrin.com/headache-and-migraine-academy/headaches/headache-prevention/headache-prevention-techniques/

  There are many different headache prevention techniques. There is no simple solution, and every treatment plan should be individualized. The key is to know your headaches and develop a personalized approach. […] The following headache prevention techniques and tips will help you control headaches so they no longer interfere with your life. […] Perhaps the most important tool in headache prevention is the headache diary. […] A number of foods and ingredients can trigger headaches. […] Removing problematic foods from your diet may help you prevent future headaches. […] A healthy diet that contains adequate amounts of vitamins, minerals and other nutrients might make a big difference. […] Insufficient sleep can trigger and exacerbate headaches, especially tension-type headaches and migraines. […] Set and commit to a consistent sleep schedule, even on weekends. […] Aerobic exercise has been shown to make an appreciable difference in reducing headaches and promoting a general sense of well-being.

• #37 Tension-type headaches: Self-care measures for relief

  https://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20047631

  Be mindful of common pain medicines. You can buy pain medicine at the store. But using this medicine more than nine days a month can make headaches harder to treat. […] Quit smoking. The nicotine in cigarette smoke reduces blood flow to the brain. It also triggers a reaction in the nerves at the back of the throat. These changes can lead to a headache. […] Stress and tension-type headaches often go hand in hand. To reduce stress, try these simple tips: […] A diary may help you learn what triggers your tension-type headaches. Note when your headaches start and your activities. Also record how long the headaches last and anything that provides relief. The diary may help you spot patterns in your daily habits that may lead to headaches. […] Look for improvements in your headaches as you make additional healthy lifestyle changes.

• #38 Tension Headaches: Causes, Symptoms, and Treatments

  https://www.healthline.com/health/tension-headache

  Since tension headaches are often caused by specific triggers, identifying the factors that cause your headaches is one way to prevent future episodes. […] A headache diary can help you determine the cause of your tension headaches. […] For each day that you have a tension headache, make a note of it. After several weeks or months, you may be able to make a connection. […] For example, if your journal shows that headaches occurred on days when you ate a particular food, that food may be your trigger.

• #39 Patient education: Headache treatment in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-treatment-in-adults-beyond-the-basics/print

  Preventive treatment — Preventive therapy is recommended for people with tension-type headaches that are frequent, such as those that occur nine or more days each month. Preventive therapy is also recommended when headaches are long-lasting or have a significant impact on a person’s ability to do their normal activities. […] Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline. The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work. […] Other medicines such as mirtazapine, topiramate, or gabapentin may also be used to help prevent frequent tension headaches. […] These medicines are often used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache.

• #40 Chronic Tension Headache: Causes and Treatment

  https://patient.info/brain-nerves/headache-leaflet/chronic-tension-headache

  Chronic tension headache is a condition where you have a tension headache on at least 15 days every month for at least three months. […] A medicine called amitriptyline may help to prevent the headaches from occurring. […] Amitriptyline is the medicine most commonly used to treat chronic tension headaches. This medicine is not a painkiller and so does not take away a headache if a headache develops. It needs to be taken every day to reduce how often headaches occur. […] The aims of preventative treatment are to reduce the number of headaches, or reduce their severity, or both. So, with treatment, the headaches may not go completely, but they will often develop less often and be less severe.

• #41 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Migraines impose significant health and financial burdens. Approximately 38% of patients with episodic migraines would benefit from preventive therapy, but less than 13% take prophylactic medications. Preventive medication therapy reduces migraine frequency, severity, and headache-related distress. Preventive therapy may also improve quality of life and prevent the progression to chronic migraines. Some indications for preventive therapy include four or more headaches a month, eight or more headache days a month, debilitating headaches, and medication-overuse headaches. […] Identifying and managing environmental, dietary, and behavioral triggers are useful strategies for preventing migraines. […] Preventive therapy for episodic migraines may decrease headache frequency, severity, and prevent progression to chronic migraines.

• #42 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Considerations for starting prophylactic treatment include the following: having four or more headaches a month or at least eight headache days a month, debilitating attacks despite appropriate acute management, difficulty tolerating or having a contraindication to acute therapy, medication-overuse headache, patient preference, or the presence of certain migraine subtypes (i.e., hemiplegic migraine; migraine with brainstem aura; migrainous infarction; or frequent, persistent, or uncomfortable aura symptoms). […] Once the need for prophylactic treatment is established, adhering to the following consensus-based principles of care may improve the success of preventive therapy. […] Start therapy with medications that have the highest level of evidence-based effectiveness. […] Behavioral treatments, such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive behavior therapy, are effective options for migraine prevention.

• #43 Chronic Tension Headache: Causes and Treatment

  https://patient.info/brain-nerves/headache-leaflet/chronic-tension-headache

  Chronic tension headache is a condition where you have a tension headache on at least 15 days every month for at least three months. […] A medicine called amitriptyline may help to prevent the headaches from occurring. […] Amitriptyline is the medicine most commonly used to treat chronic tension headaches. This medicine is not a painkiller and so does not take away a headache if a headache develops. It needs to be taken every day to reduce how often headaches occur. […] The aims of preventative treatment are to reduce the number of headaches, or reduce their severity, or both. So, with treatment, the headaches may not go completely, but they will often develop less often and be less severe.

• #44

  https://bpac.org.nz/2017/headache.aspx

  Tension-type headache is managed by identifying and avoiding causative factors, such as a non-ergonomic work station set-up; referral for physiotherapy may be appropriate if there is musculoskeletal involvement. Naproxen, ibuprofen or aspirin are the first-line pharmacological treatments; paracetamol can also be used. Prophylactic treatment with naproxen or a tricyclic antidepressant may be considered for patients with recurrent tension-type headaches. […] For patients with tension-type headache on 15 days or more a month, i.e. chronic tension-type headache, a three week course of naproxen, 250-500 mg, twice daily, may be considered. This practice does increase the risk of medicine overuse headache, however, it can be helpful in breaking the cycle of recurring headaches where the patient responds to pain with analgesics. If the three week NSAID course does not break the cycle of symptoms it should not be repeated.

• #45 Patient education: Headache treatment in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-treatment-in-adults-beyond-the-basics/print

  Preventive treatment — Preventive therapy is recommended for people with tension-type headaches that are frequent, such as those that occur nine or more days each month. Preventive therapy is also recommended when headaches are long-lasting or have a significant impact on a person’s ability to do their normal activities. […] Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline. The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work. […] Other medicines such as mirtazapine, topiramate, or gabapentin may also be used to help prevent frequent tension headaches. […] These medicines are often used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache.

• #46 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Considerations for starting prophylactic treatment include the following: having four or more headaches a month or at least eight headache days a month, debilitating attacks despite appropriate acute management, difficulty tolerating or having a contraindication to acute therapy, medication-overuse headache, patient preference, or the presence of certain migraine subtypes (i.e., hemiplegic migraine; migraine with brainstem aura; migrainous infarction; or frequent, persistent, or uncomfortable aura symptoms). […] Once the need for prophylactic treatment is established, adhering to the following consensus-based principles of care may improve the success of preventive therapy. […] Start therapy with medications that have the highest level of evidence-based effectiveness. […] Behavioral treatments, such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive behavior therapy, are effective options for migraine prevention.

• #47 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Considerations for starting prophylactic treatment include the following: having four or more headaches a month or at least eight headache days a month, debilitating attacks despite appropriate acute management, difficulty tolerating or having a contraindication to acute therapy, medication-overuse headache, patient preference, or the presence of certain migraine subtypes (i.e., hemiplegic migraine; migraine with brainstem aura; migrainous infarction; or frequent, persistent, or uncomfortable aura symptoms). […] Once the need for prophylactic treatment is established, adhering to the following consensus-based principles of care may improve the success of preventive therapy. […] Start therapy with medications that have the highest level of evidence-based effectiveness. […] Behavioral treatments, such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive behavior therapy, are effective options for migraine prevention.

• #48 Tension headache – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tension-headache/diagnosis-treatment/drc-20353982

  Your health care professional may prescribe medicines that help you have fewer headaches or headaches that are less painful. Preventive medicines may help if you have regular headaches that aren’t relieved by pain medicine and other therapies. […] Preventive medicines may include: […] Tricyclic antidepressants are the most commonly used medicines to prevent tension-type headaches. They include amitriptyline, nortriptyline (Pamelor) and protriptyline. […] The anti-seizure medicines gabapentin (Gralise, Horizant, Neurontin) and topiramate (Topamax, Qsymia, others) may help prevent headache pain. […] It can take several weeks or more for preventive medicines to build up in your system and take effect. […] Your health care professional monitors your treatment to see how the preventive medicine is working. In the meantime, overusing pain relievers may interfere with the effects of the preventive medicines. Ask your health care professional about how often to use pain relievers while you’re taking preventive medicine.

• #49 Tension-Type Headache | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0901/p797.html

  Amitriptyline is the most widely researched prophylactic agent for frequent headaches. […] A wide variety of prophylactic agents have been researched in the management of chronic tension-type headache, and comprehensive reviews are available for interested readers. […] Amitriptyline (Elavil) is the most researched of the prophylactic agents for chronic tension-type headache. It is typically used in doses of 10 to 75 mg, one to two hours before bedtime to minimize grogginess on awakening. Double-blind randomized controlled studies confirm its use in patients with chronic tension-type headache. […] Selective serotonin reuptake inhibitors (SSRIs) cause fewer side effects, and several of these agents (paroxetine [Paxil], venlafaxine [Effexor], and fluoxetine [Prozac]) have shown their efficacy in the prophylaxis of chronic tension-type headache in small studies. […] Smoking cessation is an important issue to address in patients with chronic tension-type headache. The number of cigarettes smoked has been significantly related to the headache index score and to the number of days with headache each week.

• #50 Tension-Type Headache | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0901/p797.html

  Amitriptyline is the most widely researched prophylactic agent for frequent headaches. […] A wide variety of prophylactic agents have been researched in the management of chronic tension-type headache, and comprehensive reviews are available for interested readers. […] Amitriptyline (Elavil) is the most researched of the prophylactic agents for chronic tension-type headache. It is typically used in doses of 10 to 75 mg, one to two hours before bedtime to minimize grogginess on awakening. Double-blind randomized controlled studies confirm its use in patients with chronic tension-type headache. […] Selective serotonin reuptake inhibitors (SSRIs) cause fewer side effects, and several of these agents (paroxetine [Paxil], venlafaxine [Effexor], and fluoxetine [Prozac]) have shown their efficacy in the prophylaxis of chronic tension-type headache in small studies. […] Smoking cessation is an important issue to address in patients with chronic tension-type headache. The number of cigarettes smoked has been significantly related to the headache index score and to the number of days with headache each week.

• #51 Drug and Nondrug Treatment in Tension-type Headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002628/

  Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Nondrug management is crucial. Information, reassurance and identification of trigger factors may be rewarding. Psychological treatments with scientific evidence for efficacy include relaxation training, EMG biofeedback and cognitive-behavioural therapy. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. The development of specific nonpharmacological and pharmacological managements for TTH with higher efficacy and fewer side effects is urgently needed. Prophylactic pharmacotherapy should be considered in patients with headaches on more than 15 days per month; that is, in patients with chronic TTH. The tricyclic antidepressant amitriptyline is the only drug that has proven to be effective in several controlled trials in TTH. It is important that patients are informed that this is an antidepressant agent but has an independent action on pain. In general, the initial approach to prophylactic pharmacotherapy of chronic TTH is through the use of amitriptyline. More efficient prophylactic drugs with fewer side effects are urgently needed for the preventive treatment of TTH. […] As neither nonpharmacological nor pharmacological management is highly efficient it is usually recommended to combine multiple strategies, although proper evidence is lacking.

• #52 Tension-Type Headache | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0901/p797.html

  Amitriptyline is the most widely researched prophylactic agent for frequent headaches. […] A wide variety of prophylactic agents have been researched in the management of chronic tension-type headache, and comprehensive reviews are available for interested readers. […] Amitriptyline (Elavil) is the most researched of the prophylactic agents for chronic tension-type headache. It is typically used in doses of 10 to 75 mg, one to two hours before bedtime to minimize grogginess on awakening. Double-blind randomized controlled studies confirm its use in patients with chronic tension-type headache. […] Selective serotonin reuptake inhibitors (SSRIs) cause fewer side effects, and several of these agents (paroxetine [Paxil], venlafaxine [Effexor], and fluoxetine [Prozac]) have shown their efficacy in the prophylaxis of chronic tension-type headache in small studies. […] Smoking cessation is an important issue to address in patients with chronic tension-type headache. The number of cigarettes smoked has been significantly related to the headache index score and to the number of days with headache each week.

• #53

  https://bpac.org.nz/2017/headache.aspx

  A tricyclic antidepressant (TCA) may also be considered for the prophylaxis of recurrent tension-type headache (unapproved indication). Amitriptyline, initially 5-10 mg, one to two hours before bedtime and titrated slowly upwards if necessary (e.g. every three weeks), usually to a maintenance dose of no more than 50-75 mg, is often prescribed for headache prophylaxis, although nortriptyline may be better tolerated. Withdrawal of the TCA is recommended after an improvement in symptoms has been maintained for three to six months.

• #54 Tension-Type Headache | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0901/p797.html

  Amitriptyline is the most widely researched prophylactic agent for frequent headaches. […] A wide variety of prophylactic agents have been researched in the management of chronic tension-type headache, and comprehensive reviews are available for interested readers. […] Amitriptyline (Elavil) is the most researched of the prophylactic agents for chronic tension-type headache. It is typically used in doses of 10 to 75 mg, one to two hours before bedtime to minimize grogginess on awakening. Double-blind randomized controlled studies confirm its use in patients with chronic tension-type headache. […] Selective serotonin reuptake inhibitors (SSRIs) cause fewer side effects, and several of these agents (paroxetine [Paxil], venlafaxine [Effexor], and fluoxetine [Prozac]) have shown their efficacy in the prophylaxis of chronic tension-type headache in small studies. […] Smoking cessation is an important issue to address in patients with chronic tension-type headache. The number of cigarettes smoked has been significantly related to the headache index score and to the number of days with headache each week.

• #55 Tension headache – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tension-headache/diagnosis-treatment/drc-20353982

  Your health care professional may prescribe medicines that help you have fewer headaches or headaches that are less painful. Preventive medicines may help if you have regular headaches that aren’t relieved by pain medicine and other therapies. […] Preventive medicines may include: […] Tricyclic antidepressants are the most commonly used medicines to prevent tension-type headaches. They include amitriptyline, nortriptyline (Pamelor) and protriptyline. […] The anti-seizure medicines gabapentin (Gralise, Horizant, Neurontin) and topiramate (Topamax, Qsymia, others) may help prevent headache pain. […] It can take several weeks or more for preventive medicines to build up in your system and take effect. […] Your health care professional monitors your treatment to see how the preventive medicine is working. In the meantime, overusing pain relievers may interfere with the effects of the preventive medicines. Ask your health care professional about how often to use pain relievers while you’re taking preventive medicine.

• #56

  https://bpac.org.nz/2017/headache.aspx

  A tricyclic antidepressant (TCA) may also be considered for the prophylaxis of recurrent tension-type headache (unapproved indication). Amitriptyline, initially 5-10 mg, one to two hours before bedtime and titrated slowly upwards if necessary (e.g. every three weeks), usually to a maintenance dose of no more than 50-75 mg, is often prescribed for headache prophylaxis, although nortriptyline may be better tolerated. Withdrawal of the TCA is recommended after an improvement in symptoms has been maintained for three to six months.

• #57 Patient education: Headache treatment in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-treatment-in-adults-beyond-the-basics/print

  Preventive treatment — Preventive therapy is recommended for people with tension-type headaches that are frequent, such as those that occur nine or more days each month. Preventive therapy is also recommended when headaches are long-lasting or have a significant impact on a person’s ability to do their normal activities. […] Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline. The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work. […] Other medicines such as mirtazapine, topiramate, or gabapentin may also be used to help prevent frequent tension headaches. […] These medicines are often used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache.

• #58 Patient education: Headache treatment in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-treatment-in-adults-beyond-the-basics/print

  Preventive treatment — Preventive therapy is recommended for people with tension-type headaches that are frequent, such as those that occur nine or more days each month. Preventive therapy is also recommended when headaches are long-lasting or have a significant impact on a person’s ability to do their normal activities. […] Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline. The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work. […] Other medicines such as mirtazapine, topiramate, or gabapentin may also be used to help prevent frequent tension headaches. […] These medicines are often used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache.

• #59 Tension headache – Wikipedia

  https://en.wikipedia.org/wiki/Tension_headache

  Tension headache, stress headache, or tension-type headache (TTH), is the most common type of primary headache. […] Tricyclic antidepressants appear to be useful for prevention. […] People who have 15 or more headaches in a month may be treated with certain types of daily antidepressants which act to prevent continued tension headaches from occurring. […] In those who are predisposed to tension type headaches the first-line preventative treatment is amitriptyline, whereas mirtazapine and venlafaxine are second-line treatment options. […] Tricyclic antidepressants have been found to be more effective than SSRIs but have greater side effects. […] Evidence is poor for the use of SSRIs, propranolol, and muscle relaxants for prevention of tension headaches. […] Good posture might prevent headaches if there is neck pain.

• #60 Tension headache – Wikipedia

  https://en.wikipedia.org/wiki/Tension_headache

  Tension headache, stress headache, or tension-type headache (TTH), is the most common type of primary headache. […] Tricyclic antidepressants appear to be useful for prevention. […] People who have 15 or more headaches in a month may be treated with certain types of daily antidepressants which act to prevent continued tension headaches from occurring. […] In those who are predisposed to tension type headaches the first-line preventative treatment is amitriptyline, whereas mirtazapine and venlafaxine are second-line treatment options. […] Tricyclic antidepressants have been found to be more effective than SSRIs but have greater side effects. […] Evidence is poor for the use of SSRIs, propranolol, and muscle relaxants for prevention of tension headaches. […] Good posture might prevent headaches if there is neck pain.

• #61 Tension-Type Headache | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0901/p797.html

  Amitriptyline is the most widely researched prophylactic agent for frequent headaches. […] A wide variety of prophylactic agents have been researched in the management of chronic tension-type headache, and comprehensive reviews are available for interested readers. […] Amitriptyline (Elavil) is the most researched of the prophylactic agents for chronic tension-type headache. It is typically used in doses of 10 to 75 mg, one to two hours before bedtime to minimize grogginess on awakening. Double-blind randomized controlled studies confirm its use in patients with chronic tension-type headache. […] Selective serotonin reuptake inhibitors (SSRIs) cause fewer side effects, and several of these agents (paroxetine [Paxil], venlafaxine [Effexor], and fluoxetine [Prozac]) have shown their efficacy in the prophylaxis of chronic tension-type headache in small studies. […] Smoking cessation is an important issue to address in patients with chronic tension-type headache. The number of cigarettes smoked has been significantly related to the headache index score and to the number of days with headache each week.

• #62 Center for Headache Medicine – Preventive medications and treatment for tension headaches.

  http://centerforheadachemedicine.com/tension-preventive.html

  A few medications taken at regular intervals may reduce the frequency and severity of attacks of tensions headaches, but in general the chronic form of this headache is a more difficult headache to treat with daily preventive medications. […] If you have frequent tension headaches that aren’t relieved by OTC analgesic medication and nondrug therapy such as stress management, you are a candidate for preventative medication. […] Preventive medications may require several weeks or more to build up in your nervous system before they take effect. […] Overusing caffeine or painkillers for acute relief may reduce the effect of the preventive drug. […] Tricyclic antidepressants, including amitriptyline (Elavil) and nortriptyline (Pamelor), are the most commonly used medications to prevent tension headache. […] Antidepressants such as paroxetine (Paxil), venlafaxine (Effexor, Venlafaxine HCL Er) and fluoxetine (Prozac) produce fewer side effects than do the tricyclic antidepressants but aren’t as effective for tension headaches or in most cases do not help at all.

• #63 Tension-Type Headache Prevention

  https://bellaireneurology.com/headaches/tension-prevention.html

  When patients begin to have chronic tension-type headaches more than 15 days a month, then it is necessary to avoid the medications mentioned in the acute treatment page. This is because overuse of any pain medication can lead to rebound headache where the pain medicine itself causes the headaches to continue. These headaches are the hardest headaches to treat. […] The best studied medication to prevent chronic tension-type headaches is Zanaflex (tizanidine). […] The best studied medication of this class is Prozac (fluoxetine). Prozac has the advantage of also being available in a once weekly dose. […] If a patient fails the more common treatments above, both Neurontin and Botulinum toxin (Botox) are gaining use. Neurontin is the safest of all of the oral medications used for this condition and therefore will sometimes be used first if a patient is taking a significant number of simultaneous medications. Botulinum toxin has even fewer side effects but costs substantially more and is rarely covered by insurance companies for the treatment of headaches. It also has to be repeated every 3 months. The high cost of botulinum toxin is one reason why it is used less frequently than other options.

• #64 Tension headache – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tension-headache/diagnosis-treatment/drc-20353982

  Your health care professional may prescribe medicines that help you have fewer headaches or headaches that are less painful. Preventive medicines may help if you have regular headaches that aren’t relieved by pain medicine and other therapies. […] Preventive medicines may include: […] Tricyclic antidepressants are the most commonly used medicines to prevent tension-type headaches. They include amitriptyline, nortriptyline (Pamelor) and protriptyline. […] The anti-seizure medicines gabapentin (Gralise, Horizant, Neurontin) and topiramate (Topamax, Qsymia, others) may help prevent headache pain. […] It can take several weeks or more for preventive medicines to build up in your system and take effect. […] Your health care professional monitors your treatment to see how the preventive medicine is working. In the meantime, overusing pain relievers may interfere with the effects of the preventive medicines. Ask your health care professional about how often to use pain relievers while you’re taking preventive medicine.

• #65 Tension-Type Headache Prevention

  https://bellaireneurology.com/headaches/tension-prevention.html

  When patients begin to have chronic tension-type headaches more than 15 days a month, then it is necessary to avoid the medications mentioned in the acute treatment page. This is because overuse of any pain medication can lead to rebound headache where the pain medicine itself causes the headaches to continue. These headaches are the hardest headaches to treat. […] The best studied medication to prevent chronic tension-type headaches is Zanaflex (tizanidine). […] The best studied medication of this class is Prozac (fluoxetine). Prozac has the advantage of also being available in a once weekly dose. […] If a patient fails the more common treatments above, both Neurontin and Botulinum toxin (Botox) are gaining use. Neurontin is the safest of all of the oral medications used for this condition and therefore will sometimes be used first if a patient is taking a significant number of simultaneous medications. Botulinum toxin has even fewer side effects but costs substantially more and is rarely covered by insurance companies for the treatment of headaches. It also has to be repeated every 3 months. The high cost of botulinum toxin is one reason why it is used less frequently than other options.

• #66 Topiramate has high efficacy and tolerability in treating chronic tension-type headache | Nature Reviews Neurology

  https://www.nature.com/articles/ncpneuro0331

  Topiramate has high efficacy and tolerability in treating chronic tension-type headache. […] In a prospective open-label study, Lampl and co-workers have shown this drug to have promise in the prophylaxis of chronic tension-type headache.

• #67 Prevention of Tension Headaches | My Headache Doc | Houston Texas

  https://myheadachedoc.com/headache-and-head-pain/tension-headache/prevention-of-tension-headaches/

  When patients begin to have chronic tension-type headaches more than 15 days a month, then it is necessary to avoid the medications mentioned in the acute treatment page. […] The most commonly used medications to treat chronic tension-type headaches are medications that target serotonin (5HT) and norepinephrine (NE). […] Another medication, tizanidine, has also been shown beneficial for this type of headache.

• #68 Tension-Type Headache Prevention

  https://bellaireneurology.com/headaches/tension-prevention.html

  When patients begin to have chronic tension-type headaches more than 15 days a month, then it is necessary to avoid the medications mentioned in the acute treatment page. This is because overuse of any pain medication can lead to rebound headache where the pain medicine itself causes the headaches to continue. These headaches are the hardest headaches to treat. […] The best studied medication to prevent chronic tension-type headaches is Zanaflex (tizanidine). […] The best studied medication of this class is Prozac (fluoxetine). Prozac has the advantage of also being available in a once weekly dose. […] If a patient fails the more common treatments above, both Neurontin and Botulinum toxin (Botox) are gaining use. Neurontin is the safest of all of the oral medications used for this condition and therefore will sometimes be used first if a patient is taking a significant number of simultaneous medications. Botulinum toxin has even fewer side effects but costs substantially more and is rarely covered by insurance companies for the treatment of headaches. It also has to be repeated every 3 months. The high cost of botulinum toxin is one reason why it is used less frequently than other options.

• #69 Tension-Type Headache Prevention

  https://bellaireneurology.com/headaches/tension-prevention.html

  When patients begin to have chronic tension-type headaches more than 15 days a month, then it is necessary to avoid the medications mentioned in the acute treatment page. This is because overuse of any pain medication can lead to rebound headache where the pain medicine itself causes the headaches to continue. These headaches are the hardest headaches to treat. […] The best studied medication to prevent chronic tension-type headaches is Zanaflex (tizanidine). […] The best studied medication of this class is Prozac (fluoxetine). Prozac has the advantage of also being available in a once weekly dose. […] If a patient fails the more common treatments above, both Neurontin and Botulinum toxin (Botox) are gaining use. Neurontin is the safest of all of the oral medications used for this condition and therefore will sometimes be used first if a patient is taking a significant number of simultaneous medications. Botulinum toxin has even fewer side effects but costs substantially more and is rarely covered by insurance companies for the treatment of headaches. It also has to be repeated every 3 months. The high cost of botulinum toxin is one reason why it is used less frequently than other options.

• #70 Center for Headache Medicine – Preventive medications and treatment for tension headaches.

  http://centerforheadachemedicine.com/tension-preventive.html

  A few medications taken at regular intervals may reduce the frequency and severity of attacks of tensions headaches, but in general the chronic form of this headache is a more difficult headache to treat with daily preventive medications. […] If you have frequent tension headaches that aren’t relieved by OTC analgesic medication and nondrug therapy such as stress management, you are a candidate for preventative medication. […] Preventive medications may require several weeks or more to build up in your nervous system before they take effect. […] Overusing caffeine or painkillers for acute relief may reduce the effect of the preventive drug. […] Tricyclic antidepressants, including amitriptyline (Elavil) and nortriptyline (Pamelor), are the most commonly used medications to prevent tension headache. […] Antidepressants such as paroxetine (Paxil), venlafaxine (Effexor, Venlafaxine HCL Er) and fluoxetine (Prozac) produce fewer side effects than do the tricyclic antidepressants but aren’t as effective for tension headaches or in most cases do not help at all.

• #71 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  Prophylactic management of migraine in primary care should be based on SIGN guideline 155. […] Oral prophylactic treatments should be started at a low dose and gradually increased (every 1-2 weeks) to the minimum effective maximum tolerated dose. […] Oral prophylactic treatments should be continued for at least 8 weeks at either the target dose or the highest tolerated dose before assessing efficacy. […] The effectiveness of prophylactic treatment may be limited by medication overuse headache and this should be addressed in all patients. […] If an oral prophylactic medication is effective, continue the medication and review at 6-12 months, at which time a trial of withdrawal should be considered. […] Combinations of prophylactic treatments can be helpful if individual treatments are not adequately effective.

• #72 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  Prophylactic management of migraine in primary care should be based on SIGN guideline 155. […] Oral prophylactic treatments should be started at a low dose and gradually increased (every 1-2 weeks) to the minimum effective maximum tolerated dose. […] Oral prophylactic treatments should be continued for at least 8 weeks at either the target dose or the highest tolerated dose before assessing efficacy. […] The effectiveness of prophylactic treatment may be limited by medication overuse headache and this should be addressed in all patients. […] If an oral prophylactic medication is effective, continue the medication and review at 6-12 months, at which time a trial of withdrawal should be considered. […] Combinations of prophylactic treatments can be helpful if individual treatments are not adequately effective.

• #73 Tension headache – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tension-headache/diagnosis-treatment/drc-20353982

  Your health care professional may prescribe medicines that help you have fewer headaches or headaches that are less painful. Preventive medicines may help if you have regular headaches that aren’t relieved by pain medicine and other therapies. […] Preventive medicines may include: […] Tricyclic antidepressants are the most commonly used medicines to prevent tension-type headaches. They include amitriptyline, nortriptyline (Pamelor) and protriptyline. […] The anti-seizure medicines gabapentin (Gralise, Horizant, Neurontin) and topiramate (Topamax, Qsymia, others) may help prevent headache pain. […] It can take several weeks or more for preventive medicines to build up in your system and take effect. […] Your health care professional monitors your treatment to see how the preventive medicine is working. In the meantime, overusing pain relievers may interfere with the effects of the preventive medicines. Ask your health care professional about how often to use pain relievers while you’re taking preventive medicine.

• #74 Center for Headache Medicine – Preventive medications and treatment for tension headaches.

  http://centerforheadachemedicine.com/tension-preventive.html

  A few medications taken at regular intervals may reduce the frequency and severity of attacks of tensions headaches, but in general the chronic form of this headache is a more difficult headache to treat with daily preventive medications. […] If you have frequent tension headaches that aren’t relieved by OTC analgesic medication and nondrug therapy such as stress management, you are a candidate for preventative medication. […] Preventive medications may require several weeks or more to build up in your nervous system before they take effect. […] Overusing caffeine or painkillers for acute relief may reduce the effect of the preventive drug. […] Tricyclic antidepressants, including amitriptyline (Elavil) and nortriptyline (Pamelor), are the most commonly used medications to prevent tension headache. […] Antidepressants such as paroxetine (Paxil), venlafaxine (Effexor, Venlafaxine HCL Er) and fluoxetine (Prozac) produce fewer side effects than do the tricyclic antidepressants but aren’t as effective for tension headaches or in most cases do not help at all.

• #75 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  Prophylactic management of migraine in primary care should be based on SIGN guideline 155. […] Oral prophylactic treatments should be started at a low dose and gradually increased (every 1-2 weeks) to the minimum effective maximum tolerated dose. […] Oral prophylactic treatments should be continued for at least 8 weeks at either the target dose or the highest tolerated dose before assessing efficacy. […] The effectiveness of prophylactic treatment may be limited by medication overuse headache and this should be addressed in all patients. […] If an oral prophylactic medication is effective, continue the medication and review at 6-12 months, at which time a trial of withdrawal should be considered. […] Combinations of prophylactic treatments can be helpful if individual treatments are not adequately effective.

• #76 Center for Headache Medicine – Preventive medications and treatment for tension headaches.

  http://centerforheadachemedicine.com/tension-preventive.html

  A few medications taken at regular intervals may reduce the frequency and severity of attacks of tensions headaches, but in general the chronic form of this headache is a more difficult headache to treat with daily preventive medications. […] If you have frequent tension headaches that aren’t relieved by OTC analgesic medication and nondrug therapy such as stress management, you are a candidate for preventative medication. […] Preventive medications may require several weeks or more to build up in your nervous system before they take effect. […] Overusing caffeine or painkillers for acute relief may reduce the effect of the preventive drug. […] Tricyclic antidepressants, including amitriptyline (Elavil) and nortriptyline (Pamelor), are the most commonly used medications to prevent tension headache. […] Antidepressants such as paroxetine (Paxil), venlafaxine (Effexor, Venlafaxine HCL Er) and fluoxetine (Prozac) produce fewer side effects than do the tricyclic antidepressants but aren’t as effective for tension headaches or in most cases do not help at all.

• #77 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  Prophylactic management of migraine in primary care should be based on SIGN guideline 155. […] Oral prophylactic treatments should be started at a low dose and gradually increased (every 1-2 weeks) to the minimum effective maximum tolerated dose. […] Oral prophylactic treatments should be continued for at least 8 weeks at either the target dose or the highest tolerated dose before assessing efficacy. […] The effectiveness of prophylactic treatment may be limited by medication overuse headache and this should be addressed in all patients. […] If an oral prophylactic medication is effective, continue the medication and review at 6-12 months, at which time a trial of withdrawal should be considered. […] Combinations of prophylactic treatments can be helpful if individual treatments are not adequately effective.

• #78

  https://bpac.org.nz/2017/headache.aspx

  A tricyclic antidepressant (TCA) may also be considered for the prophylaxis of recurrent tension-type headache (unapproved indication). Amitriptyline, initially 5-10 mg, one to two hours before bedtime and titrated slowly upwards if necessary (e.g. every three weeks), usually to a maintenance dose of no more than 50-75 mg, is often prescribed for headache prophylaxis, although nortriptyline may be better tolerated. Withdrawal of the TCA is recommended after an improvement in symptoms has been maintained for three to six months.

• #79 Drug and Nondrug Treatment in Tension-type Headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002628/

  Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Nondrug management is crucial. Information, reassurance and identification of trigger factors may be rewarding. Psychological treatments with scientific evidence for efficacy include relaxation training, EMG biofeedback and cognitive-behavioural therapy. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. The development of specific nonpharmacological and pharmacological managements for TTH with higher efficacy and fewer side effects is urgently needed. Prophylactic pharmacotherapy should be considered in patients with headaches on more than 15 days per month; that is, in patients with chronic TTH. The tricyclic antidepressant amitriptyline is the only drug that has proven to be effective in several controlled trials in TTH. It is important that patients are informed that this is an antidepressant agent but has an independent action on pain. In general, the initial approach to prophylactic pharmacotherapy of chronic TTH is through the use of amitriptyline. More efficient prophylactic drugs with fewer side effects are urgently needed for the preventive treatment of TTH. […] As neither nonpharmacological nor pharmacological management is highly efficient it is usually recommended to combine multiple strategies, although proper evidence is lacking.

• #80 Drug and Nondrug Treatment in Tension-type Headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002628/

  Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Nondrug management is crucial. Information, reassurance and identification of trigger factors may be rewarding. Psychological treatments with scientific evidence for efficacy include relaxation training, EMG biofeedback and cognitive-behavioural therapy. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. The development of specific nonpharmacological and pharmacological managements for TTH with higher efficacy and fewer side effects is urgently needed. Prophylactic pharmacotherapy should be considered in patients with headaches on more than 15 days per month; that is, in patients with chronic TTH. The tricyclic antidepressant amitriptyline is the only drug that has proven to be effective in several controlled trials in TTH. It is important that patients are informed that this is an antidepressant agent but has an independent action on pain. In general, the initial approach to prophylactic pharmacotherapy of chronic TTH is through the use of amitriptyline. More efficient prophylactic drugs with fewer side effects are urgently needed for the preventive treatment of TTH. […] As neither nonpharmacological nor pharmacological management is highly efficient it is usually recommended to combine multiple strategies, although proper evidence is lacking.

• #81 Headache Prevention Techniques | Excedrin

  https://www.excedrin.com/headache-and-migraine-academy/headaches/headache-prevention/headache-prevention-techniques/

  There are many different headache prevention techniques. There is no simple solution, and every treatment plan should be individualized. The key is to know your headaches and develop a personalized approach. […] The following headache prevention techniques and tips will help you control headaches so they no longer interfere with your life. […] Perhaps the most important tool in headache prevention is the headache diary. […] A number of foods and ingredients can trigger headaches. […] Removing problematic foods from your diet may help you prevent future headaches. […] A healthy diet that contains adequate amounts of vitamins, minerals and other nutrients might make a big difference. […] Insufficient sleep can trigger and exacerbate headaches, especially tension-type headaches and migraines. […] Set and commit to a consistent sleep schedule, even on weekends. […] Aerobic exercise has been shown to make an appreciable difference in reducing headaches and promoting a general sense of well-being.

• #82 Drug and Nondrug Treatment in Tension-type Headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002628/

  Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Nondrug management is crucial. Information, reassurance and identification of trigger factors may be rewarding. Psychological treatments with scientific evidence for efficacy include relaxation training, EMG biofeedback and cognitive-behavioural therapy. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. The development of specific nonpharmacological and pharmacological managements for TTH with higher efficacy and fewer side effects is urgently needed. Prophylactic pharmacotherapy should be considered in patients with headaches on more than 15 days per month; that is, in patients with chronic TTH. The tricyclic antidepressant amitriptyline is the only drug that has proven to be effective in several controlled trials in TTH. It is important that patients are informed that this is an antidepressant agent but has an independent action on pain. In general, the initial approach to prophylactic pharmacotherapy of chronic TTH is through the use of amitriptyline. More efficient prophylactic drugs with fewer side effects are urgently needed for the preventive treatment of TTH. […] As neither nonpharmacological nor pharmacological management is highly efficient it is usually recommended to combine multiple strategies, although proper evidence is lacking.

• #83 Tension headache prevention – wikidoc

  https://www.wikidoc.org/index.php/Tension_headache_prevention

  TTH prevention and prophylactic treatment is generally indicated for chronic TTH and frequent episodic TTH. Data regarding pharmacologic prevention and prophylactic treatment is limited and not well established. Drugs that can be used are: TCA (amitriptyline), SSRI (mirtazapine, venlafaxine), and anticonvulsants (gabapentin, topiramate). […] Behavioral treatments include: relaxation, biofeedback, and CBT. […] For patients with frequent episodic or chronic TTH, combined Rx with TCA plus stress management therapy is recommended rather than alone therapy with TCA or behavioral therapy alone. (Grade 2B) […] For patients with frequent episodic or chronic TTH, having preference for pharmacologic therapy rather than behavioral therapy, TCA with amitriptyline is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, not needing pharmacologic therapy, electromyography biofeedback combined with relaxation therapy is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, who cannot tolerate or require more effective treatments such as amitriptyline and biofeedback, acupuncture (Grade 2B) or physical therapy (Grade 2C) is recommended.

• #84 Tension headache prevention – wikidoc

  https://www.wikidoc.org/index.php/Tension_headache_prevention

  TTH prevention and prophylactic treatment is generally indicated for chronic TTH and frequent episodic TTH. Data regarding pharmacologic prevention and prophylactic treatment is limited and not well established. Drugs that can be used are: TCA (amitriptyline), SSRI (mirtazapine, venlafaxine), and anticonvulsants (gabapentin, topiramate). […] Behavioral treatments include: relaxation, biofeedback, and CBT. […] For patients with frequent episodic or chronic TTH, combined Rx with TCA plus stress management therapy is recommended rather than alone therapy with TCA or behavioral therapy alone. (Grade 2B) […] For patients with frequent episodic or chronic TTH, having preference for pharmacologic therapy rather than behavioral therapy, TCA with amitriptyline is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, not needing pharmacologic therapy, electromyography biofeedback combined with relaxation therapy is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, who cannot tolerate or require more effective treatments such as amitriptyline and biofeedback, acupuncture (Grade 2B) or physical therapy (Grade 2C) is recommended.

• #85 Tension headache prevention – wikidoc

  https://www.wikidoc.org/index.php/Tension_headache_prevention

  TTH prevention and prophylactic treatment is generally indicated for chronic TTH and frequent episodic TTH. Data regarding pharmacologic prevention and prophylactic treatment is limited and not well established. Drugs that can be used are: TCA (amitriptyline), SSRI (mirtazapine, venlafaxine), and anticonvulsants (gabapentin, topiramate). […] Behavioral treatments include: relaxation, biofeedback, and CBT. […] For patients with frequent episodic or chronic TTH, combined Rx with TCA plus stress management therapy is recommended rather than alone therapy with TCA or behavioral therapy alone. (Grade 2B) […] For patients with frequent episodic or chronic TTH, having preference for pharmacologic therapy rather than behavioral therapy, TCA with amitriptyline is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, not needing pharmacologic therapy, electromyography biofeedback combined with relaxation therapy is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, who cannot tolerate or require more effective treatments such as amitriptyline and biofeedback, acupuncture (Grade 2B) or physical therapy (Grade 2C) is recommended.

• #86 Tension headache prevention – wikidoc

  https://www.wikidoc.org/index.php/Tension_headache_prevention

  TTH prevention and prophylactic treatment is generally indicated for chronic TTH and frequent episodic TTH. Data regarding pharmacologic prevention and prophylactic treatment is limited and not well established. Drugs that can be used are: TCA (amitriptyline), SSRI (mirtazapine, venlafaxine), and anticonvulsants (gabapentin, topiramate). […] Behavioral treatments include: relaxation, biofeedback, and CBT. […] For patients with frequent episodic or chronic TTH, combined Rx with TCA plus stress management therapy is recommended rather than alone therapy with TCA or behavioral therapy alone. (Grade 2B) […] For patients with frequent episodic or chronic TTH, having preference for pharmacologic therapy rather than behavioral therapy, TCA with amitriptyline is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, not needing pharmacologic therapy, electromyography biofeedback combined with relaxation therapy is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, who cannot tolerate or require more effective treatments such as amitriptyline and biofeedback, acupuncture (Grade 2B) or physical therapy (Grade 2C) is recommended.

• #87 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  The decision if or when to start oral prophylaxis should be tailored to the individual patient. […] Migraine prophylactics may take many weeks to work. […] If the migraine prophylactic is ineffective at 8 weeks, it should be weaned over 2 weeks and an alternative considered. […] If it is effective (i.e. reduced monthly headache days by at least 30-50%) consider weaning the drug after 6 to 12 months (it should be weaned at the approximate rate it was increased). […] If patients are drowsy they should be warned to refrain from driving. […] Migraine prophylaxis is usually not required in pregnancy, and certain medications are contraindicated in pregnancy. […] We recommend consideration of withdrawal of migraine prophylactics prior to conception. […] Patients should be defined as having episodic or chronic migraine using headache diaries.

• #88 Patient education: Headache treatment in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-treatment-in-adults-beyond-the-basics/print

  Preventive treatment — Preventive therapy is recommended for people with tension-type headaches that are frequent, such as those that occur nine or more days each month. Preventive therapy is also recommended when headaches are long-lasting or have a significant impact on a person’s ability to do their normal activities. […] Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline. The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work. […] Other medicines such as mirtazapine, topiramate, or gabapentin may also be used to help prevent frequent tension headaches. […] These medicines are often used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache.

• #89 Patient education: Headache treatment in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-treatment-in-adults-beyond-the-basics/print

  Preventive treatment — Preventive therapy is recommended for people with tension-type headaches that are frequent, such as those that occur nine or more days each month. Preventive therapy is also recommended when headaches are long-lasting or have a significant impact on a person’s ability to do their normal activities. […] Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline. The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work. […] Other medicines such as mirtazapine, topiramate, or gabapentin may also be used to help prevent frequent tension headaches. […] These medicines are often used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache.

• #90 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  The decision if or when to start oral prophylaxis should be tailored to the individual patient. […] Migraine prophylactics may take many weeks to work. […] If the migraine prophylactic is ineffective at 8 weeks, it should be weaned over 2 weeks and an alternative considered. […] If it is effective (i.e. reduced monthly headache days by at least 30-50%) consider weaning the drug after 6 to 12 months (it should be weaned at the approximate rate it was increased). […] If patients are drowsy they should be warned to refrain from driving. […] Migraine prophylaxis is usually not required in pregnancy, and certain medications are contraindicated in pregnancy. […] We recommend consideration of withdrawal of migraine prophylactics prior to conception. […] Patients should be defined as having episodic or chronic migraine using headache diaries.

• #91 Tension headache prevention – wikidoc

  https://www.wikidoc.org/index.php/Tension_headache_prevention

  TTH prevention and prophylactic treatment is generally indicated for chronic TTH and frequent episodic TTH. Data regarding pharmacologic prevention and prophylactic treatment is limited and not well established. Drugs that can be used are: TCA (amitriptyline), SSRI (mirtazapine, venlafaxine), and anticonvulsants (gabapentin, topiramate). […] Behavioral treatments include: relaxation, biofeedback, and CBT. […] For patients with frequent episodic or chronic TTH, combined Rx with TCA plus stress management therapy is recommended rather than alone therapy with TCA or behavioral therapy alone. (Grade 2B) […] For patients with frequent episodic or chronic TTH, having preference for pharmacologic therapy rather than behavioral therapy, TCA with amitriptyline is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, not needing pharmacologic therapy, electromyography biofeedback combined with relaxation therapy is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, who cannot tolerate or require more effective treatments such as amitriptyline and biofeedback, acupuncture (Grade 2B) or physical therapy (Grade 2C) is recommended.

• #92 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  Initial prophylaxis should be with oral medications, but it is expected that many agents will already have been tried in primary care. […] For selected patients with both episodic and chronic migraine, Flunarizine may be a treatment option. […] In selected patients with disabling high frequency episodic migraine, treatment with a gepant (rimegepant or atogepant) or a monoclonal antibody to calcitonin gene related peptide (CGRP) can be considered if first line oral prophylactics are ineffective. […] With effective migraine prevention patients can revert to episodic migraine and remain in episodic migraine once preventative treatments are phased out / discontinued. […] In patients established on a preventative treatment (oral preventatives, flunarizine, gepants, Botox and CGRP monoclonal antibodies) the need for ongoing treatment should be evaluated on a yearly basis and consideration given to a treatment holiday.

• #93 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  If headache worsens on phasing out / stopping an effective treatment this should be reinstated. […] The recommendations for the prophylaxis of migraine in secondary care reflect the advice given for prophylaxis of migraine in primary care, with sequential trials (if needed) of amitriptyline, candesartan, propranolol, and topiramate being recommended. […] Medication overuse with analgesics should be addressed prior to initiating treatment. […] Response to treatment should be assessed after 3 months using headache diaries. […] If there is a good response to treatment, the agent may be continued for a pre-defined period as determined locally (e.g. 12-24 months), before consideration of a treatment holiday. […] If there is recurrence of headache during a treatment holiday, treatment may be re-initiated.

• #94 Preventive medicines for migraine – The Migraine TrustVisualV1 – SearchVisualV1 – CrossVisualV1 – Home VisualV1 – CrossVisualV1 – DownloadVisualV1 – Arrow

  https://migrainetrust.org/live-with-migraine/healthcare/treatments/preventive-medicines/

  There are certain preventive medicines that you cannot take if you are pregnant or it’s possible you could get pregnant. This is because they can cause harm to a developing baby. […] Your doctor will want to monitor whether your medicine is helping to reduce the number of migraine attacks you get. […] If your preventive migraine medication is not helping, talk to your doctor. They can review whether they may be able to increase your dose or try a different treatment.

• #95 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  If headache worsens on phasing out / stopping an effective treatment this should be reinstated. […] The recommendations for the prophylaxis of migraine in secondary care reflect the advice given for prophylaxis of migraine in primary care, with sequential trials (if needed) of amitriptyline, candesartan, propranolol, and topiramate being recommended. […] Medication overuse with analgesics should be addressed prior to initiating treatment. […] Response to treatment should be assessed after 3 months using headache diaries. […] If there is a good response to treatment, the agent may be continued for a pre-defined period as determined locally (e.g. 12-24 months), before consideration of a treatment holiday. […] If there is recurrence of headache during a treatment holiday, treatment may be re-initiated.

• #96 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  If headache worsens on phasing out / stopping an effective treatment this should be reinstated. […] The recommendations for the prophylaxis of migraine in secondary care reflect the advice given for prophylaxis of migraine in primary care, with sequential trials (if needed) of amitriptyline, candesartan, propranolol, and topiramate being recommended. […] Medication overuse with analgesics should be addressed prior to initiating treatment. […] Response to treatment should be assessed after 3 months using headache diaries. […] If there is a good response to treatment, the agent may be continued for a pre-defined period as determined locally (e.g. 12-24 months), before consideration of a treatment holiday. […] If there is recurrence of headache during a treatment holiday, treatment may be re-initiated.

• #97 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  If headache worsens on phasing out / stopping an effective treatment this should be reinstated. […] The recommendations for the prophylaxis of migraine in secondary care reflect the advice given for prophylaxis of migraine in primary care, with sequential trials (if needed) of amitriptyline, candesartan, propranolol, and topiramate being recommended. […] Medication overuse with analgesics should be addressed prior to initiating treatment. […] Response to treatment should be assessed after 3 months using headache diaries. […] If there is a good response to treatment, the agent may be continued for a pre-defined period as determined locally (e.g. 12-24 months), before consideration of a treatment holiday. […] If there is recurrence of headache during a treatment holiday, treatment may be re-initiated.

• #98 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  In patients continuing treatment beyond 12-24 months, the need for ongoing treatment should be evaluated on a yearly basis. […] Botulinum toxin A therapy is licensed for chronic migraine only (defined as at least 15 headache days per month, at least 8 of which are migraine). […] Treatment should be continued where there is a good response to treatment but the patient continues to suffer a significant headache burden (e.g remains in a chronic migraine pattern). […] Monoclonal antibodies to calcitonin gene related peptide (CGRP) are a new class of medications for the treatment of migraine. […] In the majority of centres, these agents should be trialled for patients with chronic migraine who have not responded to the oral prophylactics nor Botulinum toxin A. […] In selected patients with high frequency episodic migraine there is the option to treat with a monoclonal antibody to CGRP (fremanezumab, galcanezumab and eptinezumab are licensed in this scenario) if oral prophylactics are ineffective.

• #99 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  If headache worsens on phasing out / stopping an effective treatment this should be reinstated. […] The recommendations for the prophylaxis of migraine in secondary care reflect the advice given for prophylaxis of migraine in primary care, with sequential trials (if needed) of amitriptyline, candesartan, propranolol, and topiramate being recommended. […] Medication overuse with analgesics should be addressed prior to initiating treatment. […] Response to treatment should be assessed after 3 months using headache diaries. […] If there is a good response to treatment, the agent may be continued for a pre-defined period as determined locally (e.g. 12-24 months), before consideration of a treatment holiday. […] If there is recurrence of headache during a treatment holiday, treatment may be re-initiated.

• #100

  https://bpac.org.nz/2017/headache.aspx

  Tension-type headache is managed by identifying and avoiding causative factors, such as a non-ergonomic work station set-up; referral for physiotherapy may be appropriate if there is musculoskeletal involvement. Naproxen, ibuprofen or aspirin are the first-line pharmacological treatments; paracetamol can also be used. Prophylactic treatment with naproxen or a tricyclic antidepressant may be considered for patients with recurrent tension-type headaches. […] For patients with tension-type headache on 15 days or more a month, i.e. chronic tension-type headache, a three week course of naproxen, 250-500 mg, twice daily, may be considered. This practice does increase the risk of medicine overuse headache, however, it can be helpful in breaking the cycle of recurring headaches where the patient responds to pain with analgesics. If the three week NSAID course does not break the cycle of symptoms it should not be repeated.

• #101

  https://bpac.org.nz/2017/headache.aspx

  Tension-type headache is managed by identifying and avoiding causative factors, such as a non-ergonomic work station set-up; referral for physiotherapy may be appropriate if there is musculoskeletal involvement. Naproxen, ibuprofen or aspirin are the first-line pharmacological treatments; paracetamol can also be used. Prophylactic treatment with naproxen or a tricyclic antidepressant may be considered for patients with recurrent tension-type headaches. […] For patients with tension-type headache on 15 days or more a month, i.e. chronic tension-type headache, a three week course of naproxen, 250-500 mg, twice daily, may be considered. This practice does increase the risk of medicine overuse headache, however, it can be helpful in breaking the cycle of recurring headaches where the patient responds to pain with analgesics. If the three week NSAID course does not break the cycle of symptoms it should not be repeated.

• #102

  https://bpac.org.nz/2017/headache.aspx

  Tension-type headache is managed by identifying and avoiding causative factors, such as a non-ergonomic work station set-up; referral for physiotherapy may be appropriate if there is musculoskeletal involvement. Naproxen, ibuprofen or aspirin are the first-line pharmacological treatments; paracetamol can also be used. Prophylactic treatment with naproxen or a tricyclic antidepressant may be considered for patients with recurrent tension-type headaches. […] For patients with tension-type headache on 15 days or more a month, i.e. chronic tension-type headache, a three week course of naproxen, 250-500 mg, twice daily, may be considered. This practice does increase the risk of medicine overuse headache, however, it can be helpful in breaking the cycle of recurring headaches where the patient responds to pain with analgesics. If the three week NSAID course does not break the cycle of symptoms it should not be repeated.

• #103

  https://bpac.org.nz/2017/headache.aspx

  Tension-type headache is managed by identifying and avoiding causative factors, such as a non-ergonomic work station set-up; referral for physiotherapy may be appropriate if there is musculoskeletal involvement. Naproxen, ibuprofen or aspirin are the first-line pharmacological treatments; paracetamol can also be used. Prophylactic treatment with naproxen or a tricyclic antidepressant may be considered for patients with recurrent tension-type headaches. […] For patients with tension-type headache on 15 days or more a month, i.e. chronic tension-type headache, a three week course of naproxen, 250-500 mg, twice daily, may be considered. This practice does increase the risk of medicine overuse headache, however, it can be helpful in breaking the cycle of recurring headaches where the patient responds to pain with analgesics. If the three week NSAID course does not break the cycle of symptoms it should not be repeated.

• #104

• #105 Headache prophylaxis • LITFL • Neurology library

  https://litfl.com/headache-prophylaxis/

  There are many options when it comes to deciding on the right prophylactic medicine for your headache patient: anti-epileptic (anticonvulsant) drugs, antidepressants, beta-blockers, and calcium channel blockers. […] Antidepressants listed below have all been found to be effective in tension-type headache as well as migraine. […] Beta-blockers (such as propranolol, metoprolol, atenolol, timolol and nadolol) are often used as a first line treatment when there is comorbid hypertension or anxiety. […] Calcium channel blockers (such as verapamil and flunarizine) are also effective prophylactic agents for patients suffering from migraines.

• #106 Preventive medicines for migraine – The Migraine TrustVisualV1 – SearchVisualV1 – CrossVisualV1 – Home VisualV1 – CrossVisualV1 – DownloadVisualV1 – Arrow

  https://migrainetrust.org/live-with-migraine/healthcare/treatments/preventive-medicines/

  There are certain preventive medicines that you cannot take if you are pregnant or it’s possible you could get pregnant. This is because they can cause harm to a developing baby. […] Your doctor will want to monitor whether your medicine is helping to reduce the number of migraine attacks you get. […] If your preventive migraine medication is not helping, talk to your doctor. They can review whether they may be able to increase your dose or try a different treatment.

• #107 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  The decision if or when to start oral prophylaxis should be tailored to the individual patient. […] Migraine prophylactics may take many weeks to work. […] If the migraine prophylactic is ineffective at 8 weeks, it should be weaned over 2 weeks and an alternative considered. […] If it is effective (i.e. reduced monthly headache days by at least 30-50%) consider weaning the drug after 6 to 12 months (it should be weaned at the approximate rate it was increased). […] If patients are drowsy they should be warned to refrain from driving. […] Migraine prophylaxis is usually not required in pregnancy, and certain medications are contraindicated in pregnancy. […] We recommend consideration of withdrawal of migraine prophylactics prior to conception. […] Patients should be defined as having episodic or chronic migraine using headache diaries.

• #108 Headache Treatment

  https://www.nationwidechildrens.org/specialties/headache-clinic/headache-treatment

  Topiramate (Topamax): This is a seizure prevention medicine which is also approved by the FDA for headache prevention in adults. It is used commonly in children with headaches. Dosing for headache prevention is much lower than dosing for seizure prevention. […] Propranolol: This is a beta blocker medicine which can help prevent migraine headaches. It should not be used for patients with asthma, diabetes, bradycardia (low heart rates), congestive heart failure or depression. This medicine is FDA approved for headache prevention in adults. […] Valproic Acid (Depakote): This is a seizure prevention medicine, but is also FDA approved for headache prevention in adults. It can be used in children with headaches. […] Levitiracetam (Keppra): This is a seizure prevention medicine but is also used for headache prevention in adults and children.

• #109 New Treatment Options for Headaches | Cedars-Sinai

  https://www.cedars-sinai.org/blog/new-headache-treatment-options.html

  Monoclonal antibodies […] This new class of migraine-prevention therapies target the calcitonin gene-related peptide (CGRP) pathway, a protein linked to migraine symptoms. […] Another newer group of drugs targets the same molecule but is provided orally. […] The ability to take Nurtec both for prevention and acute treatment implies that it does not have the same overuse limitations as existing drugs, Dr. Shadbehr notes. […] Providers suggest taking acute headache treatments no more than 10 days each month, because overindulging in either over-the-counter drugs or triptans can cause headaches. […] „For people finding they need to take a lot of breakthrough medications, gepants would be a good option because they’re less likely to develop rebound headaches,” she says. […] These innovations open the door for migraine patients with heart disease, stroke and vascular diseases, who couldn’t safely take the older class of triptan migraine medications.

• #110 New Treatment Options for Headaches | Cedars-Sinai

  https://www.cedars-sinai.org/blog/new-headache-treatment-options.html

  Monoclonal antibodies […] This new class of migraine-prevention therapies target the calcitonin gene-related peptide (CGRP) pathway, a protein linked to migraine symptoms. […] Another newer group of drugs targets the same molecule but is provided orally. […] The ability to take Nurtec both for prevention and acute treatment implies that it does not have the same overuse limitations as existing drugs, Dr. Shadbehr notes. […] Providers suggest taking acute headache treatments no more than 10 days each month, because overindulging in either over-the-counter drugs or triptans can cause headaches. […] „For people finding they need to take a lot of breakthrough medications, gepants would be a good option because they’re less likely to develop rebound headaches,” she says. […] These innovations open the door for migraine patients with heart disease, stroke and vascular diseases, who couldn’t safely take the older class of triptan migraine medications.

• #111 New Treatment Options for Headaches | Cedars-Sinai

  https://www.cedars-sinai.org/blog/new-headache-treatment-options.html

  Monoclonal antibodies […] This new class of migraine-prevention therapies target the calcitonin gene-related peptide (CGRP) pathway, a protein linked to migraine symptoms. […] Another newer group of drugs targets the same molecule but is provided orally. […] The ability to take Nurtec both for prevention and acute treatment implies that it does not have the same overuse limitations as existing drugs, Dr. Shadbehr notes. […] Providers suggest taking acute headache treatments no more than 10 days each month, because overindulging in either over-the-counter drugs or triptans can cause headaches. […] „For people finding they need to take a lot of breakthrough medications, gepants would be a good option because they’re less likely to develop rebound headaches,” she says. […] These innovations open the door for migraine patients with heart disease, stroke and vascular diseases, who couldn’t safely take the older class of triptan migraine medications.

• #112 New Treatment Options for Headaches | Cedars-Sinai

  https://www.cedars-sinai.org/blog/new-headache-treatment-options.html

  Additionally, patients on this new class of drugs are able to get onto a full dose earlier than the adjustment period required to test your reaction and build up to classic headache medications. […] There are caveats: Patients need to try other treatments before insurance will approve one of the new ones. […] Botox is FDA-approved for chronic migraines in adults who have at least 15 headache days a month with each headache lasting four or more hours. […] Trigger point injections target muscles to address co-occurring myofascial and chronic neck and shoulder pain, and nerve blocks address concurrent neuralgias and help break up frequent headache cycles. […] Lifestyle changes are also key, Dr. Shadbehr says. Getting enough sleep, hydrating and limiting caffeine can all ease headache symptoms. […] There are individualized treatment plans available to help alleviate chronic headaches and improve your quality of life.

• #113 Tension headaches

  https://www.nhs.uk/conditions/tension-headaches/

  If you get tension headaches regularly, you may be offered a course of acupuncture. […] An antidepressant medicine called amitriptyline is also sometimes recommended to help prevent tension headaches. […] You’ll be prescribed a low-dose to start with, which may later be increased. The medicine usually needs to be taken for several months before it starts working.

• #114 Headache prevention – Catch it before it starts | Evergreen Life

  https://www.evergreen-life.co.uk/health-wellbeing-library/headache-prevention/

  Effective headache prevention may vary depending on which type you’re trying to avoid […] Tips for preventing headaches […] Keep a headache diary If you’re no stranger to regular headaches, maintaining a record of when they start, duration and what you were doing at the time they began can help you spot your unique headache triggers, so you know what to avoid or minimise. […] Prioritise sleep The Sleep Foundation advises adults aged 18-64 get seven-nine hours of sleep, whilst the recommended sleep time for those aged 65 and above is seven-eight hours. […] Stay clear of overdoing the medication, specifically painkillers like paracetamol and codeine Although you may think over-the-counter medications for headaches can help, taking some more than twice a week can actually make your headaches more intense and frequent.

• #115 Tension headaches

  https://www.nhs.uk/conditions/tension-headaches/

  If you get tension headaches regularly, you may be offered a course of acupuncture. […] An antidepressant medicine called amitriptyline is also sometimes recommended to help prevent tension headaches. […] You’ll be prescribed a low-dose to start with, which may later be increased. The medicine usually needs to be taken for several months before it starts working.

• #116 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Petasites has been established as effective and can be considered for migraine prevention. […] Several medications have been studied for the prevention of episodic migraines. Based on guidelines from the American Headache Society and the American Academy of Neurology, agents with the most quality evidence to support their use should generally be considered first for migraine prevention. […] The disabling nature of migraine headaches causes frequent visits to outpatient clinic and emergency department settings, imposing significant health and financial burdens.

• #117 Tension headaches

  https://www.nhs.uk/conditions/tension-headaches/

  If you get tension headaches regularly, you may be offered a course of acupuncture. […] An antidepressant medicine called amitriptyline is also sometimes recommended to help prevent tension headaches. […] You’ll be prescribed a low-dose to start with, which may later be increased. The medicine usually needs to be taken for several months before it starts working.

• #118 Tension headaches

  https://www.nhs.uk/conditions/tension-headaches/

  If you get tension headaches regularly, you may be offered a course of acupuncture. […] An antidepressant medicine called amitriptyline is also sometimes recommended to help prevent tension headaches. […] You’ll be prescribed a low-dose to start with, which may later be increased. The medicine usually needs to be taken for several months before it starts working.

• #119 Headache prophylaxis • LITFL • Neurology library

  https://litfl.com/headache-prophylaxis/

  Prophylactic treatments for headache pain are especially relevant for patients suffering from migraine headaches. […] In general, more than three headaches a month is enough to consider prophylactic treatment. […] Once you’ve decided that your patient is ready for a prophylactic approach to headache pain management, there are over-the-counter medicines and prescription drugs to choose from. […] We recommend certain over-the-counter supplements as prophylaxis for all patients, whether they take prescription medication or not. […] These over-the-counter preparations are magnesium oxide (400-800 mg daily) and riboflavin, or vitamin B2 (400 mg daily). […] If you begin by explaining the goals of the therapy, your patient will be able to use a headache diary to focus on the efficacy of treatment and quantify their response.

• #120 Tension headaches

  https://www.nhs.uk/conditions/tension-headaches/

  If you get tension headaches regularly, you may be offered a course of acupuncture. […] An antidepressant medicine called amitriptyline is also sometimes recommended to help prevent tension headaches. […] You’ll be prescribed a low-dose to start with, which may later be increased. The medicine usually needs to be taken for several months before it starts working.

• #121 Headache prophylaxis • LITFL • Neurology library

  https://litfl.com/headache-prophylaxis/

  Prophylactic treatments for headache pain are especially relevant for patients suffering from migraine headaches. […] In general, more than three headaches a month is enough to consider prophylactic treatment. […] Once you’ve decided that your patient is ready for a prophylactic approach to headache pain management, there are over-the-counter medicines and prescription drugs to choose from. […] We recommend certain over-the-counter supplements as prophylaxis for all patients, whether they take prescription medication or not. […] These over-the-counter preparations are magnesium oxide (400-800 mg daily) and riboflavin, or vitamin B2 (400 mg daily). […] If you begin by explaining the goals of the therapy, your patient will be able to use a headache diary to focus on the efficacy of treatment and quantify their response.

• #122 Headache prophylaxis • LITFL • Neurology library

  https://litfl.com/headache-prophylaxis/

  Prophylactic treatments for headache pain are especially relevant for patients suffering from migraine headaches. […] In general, more than three headaches a month is enough to consider prophylactic treatment. […] Once you’ve decided that your patient is ready for a prophylactic approach to headache pain management, there are over-the-counter medicines and prescription drugs to choose from. […] We recommend certain over-the-counter supplements as prophylaxis for all patients, whether they take prescription medication or not. […] These over-the-counter preparations are magnesium oxide (400-800 mg daily) and riboflavin, or vitamin B2 (400 mg daily). […] If you begin by explaining the goals of the therapy, your patient will be able to use a headache diary to focus on the efficacy of treatment and quantify their response.

• #123 Drug and Nondrug Treatment in Tension-type Headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002628/

  Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Nondrug management is crucial. Information, reassurance and identification of trigger factors may be rewarding. Psychological treatments with scientific evidence for efficacy include relaxation training, EMG biofeedback and cognitive-behavioural therapy. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. The development of specific nonpharmacological and pharmacological managements for TTH with higher efficacy and fewer side effects is urgently needed. Prophylactic pharmacotherapy should be considered in patients with headaches on more than 15 days per month; that is, in patients with chronic TTH. The tricyclic antidepressant amitriptyline is the only drug that has proven to be effective in several controlled trials in TTH. It is important that patients are informed that this is an antidepressant agent but has an independent action on pain. In general, the initial approach to prophylactic pharmacotherapy of chronic TTH is through the use of amitriptyline. More efficient prophylactic drugs with fewer side effects are urgently needed for the preventive treatment of TTH. […] As neither nonpharmacological nor pharmacological management is highly efficient it is usually recommended to combine multiple strategies, although proper evidence is lacking.

• #124 Tension headache prevention – wikidoc

  https://www.wikidoc.org/index.php/Tension_headache_prevention

  TTH prevention and prophylactic treatment is generally indicated for chronic TTH and frequent episodic TTH. Data regarding pharmacologic prevention and prophylactic treatment is limited and not well established. Drugs that can be used are: TCA (amitriptyline), SSRI (mirtazapine, venlafaxine), and anticonvulsants (gabapentin, topiramate). […] Behavioral treatments include: relaxation, biofeedback, and CBT. […] For patients with frequent episodic or chronic TTH, combined Rx with TCA plus stress management therapy is recommended rather than alone therapy with TCA or behavioral therapy alone. (Grade 2B) […] For patients with frequent episodic or chronic TTH, having preference for pharmacologic therapy rather than behavioral therapy, TCA with amitriptyline is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, not needing pharmacologic therapy, electromyography biofeedback combined with relaxation therapy is recommended. (Grade 2B) […] For patients with frequent episodic or chronic TTH, who cannot tolerate or require more effective treatments such as amitriptyline and biofeedback, acupuncture (Grade 2B) or physical therapy (Grade 2C) is recommended.

• #125 Tension Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/8257-tension-headaches

  Managing stress may be the most effective way to prevent a tension headache. The most effective stress management tools are the ones that you can fit into your daily routine and make you feel good. Some examples include: […] Regular exercise. […] Getting enough rest.

• #126 Tension-type headaches: Self-care measures for relief

  https://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20047631

  Headaches can interfere with daily life. But healthy lifestyle choices can help you head off the pain. Start with diet, exercise and relaxation. […] Medicines may relieve the pain. But simply taking good care of yourself may help prevent a headache. […] A healthy lifestyle can promote good overall health. It also may help prevent all types of headaches, including tension-type headaches. […] Eat nutritious foods on a regular schedule. Don’t skip meals, especially breakfast. Drink plenty of water each day. […] Exercise regularly. Exercise releases chemicals in the body that block pain signals to the brain. […] Get enough sleep. Wake up and go to bed at the same time every day even on weekends. […] Avoid large amounts of caffeine. Caffeine may help curb headaches. But heavy daily caffeine use can lead to headaches.

• #127 Drug and Nondrug Treatment in Tension-type Headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002628/

  Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Nondrug management is crucial. Information, reassurance and identification of trigger factors may be rewarding. Psychological treatments with scientific evidence for efficacy include relaxation training, EMG biofeedback and cognitive-behavioural therapy. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. The development of specific nonpharmacological and pharmacological managements for TTH with higher efficacy and fewer side effects is urgently needed. Prophylactic pharmacotherapy should be considered in patients with headaches on more than 15 days per month; that is, in patients with chronic TTH. The tricyclic antidepressant amitriptyline is the only drug that has proven to be effective in several controlled trials in TTH. It is important that patients are informed that this is an antidepressant agent but has an independent action on pain. In general, the initial approach to prophylactic pharmacotherapy of chronic TTH is through the use of amitriptyline. More efficient prophylactic drugs with fewer side effects are urgently needed for the preventive treatment of TTH. […] As neither nonpharmacological nor pharmacological management is highly efficient it is usually recommended to combine multiple strategies, although proper evidence is lacking.

• #128 Patient education: Headache treatment in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-treatment-in-adults-beyond-the-basics/print

  Preventive treatment — Preventive therapy is recommended for people with tension-type headaches that are frequent, such as those that occur nine or more days each month. Preventive therapy is also recommended when headaches are long-lasting or have a significant impact on a person’s ability to do their normal activities. […] Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline. The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work. […] Other medicines such as mirtazapine, topiramate, or gabapentin may also be used to help prevent frequent tension headaches. […] These medicines are often used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache.

• #129 Drug and Nondrug Treatment in Tension-type Headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002628/

  Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Nondrug management is crucial. Information, reassurance and identification of trigger factors may be rewarding. Psychological treatments with scientific evidence for efficacy include relaxation training, EMG biofeedback and cognitive-behavioural therapy. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. The development of specific nonpharmacological and pharmacological managements for TTH with higher efficacy and fewer side effects is urgently needed. Prophylactic pharmacotherapy should be considered in patients with headaches on more than 15 days per month; that is, in patients with chronic TTH. The tricyclic antidepressant amitriptyline is the only drug that has proven to be effective in several controlled trials in TTH. It is important that patients are informed that this is an antidepressant agent but has an independent action on pain. In general, the initial approach to prophylactic pharmacotherapy of chronic TTH is through the use of amitriptyline. More efficient prophylactic drugs with fewer side effects are urgently needed for the preventive treatment of TTH. […] As neither nonpharmacological nor pharmacological management is highly efficient it is usually recommended to combine multiple strategies, although proper evidence is lacking.

• #130 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  If headache worsens on phasing out / stopping an effective treatment this should be reinstated. […] The recommendations for the prophylaxis of migraine in secondary care reflect the advice given for prophylaxis of migraine in primary care, with sequential trials (if needed) of amitriptyline, candesartan, propranolol, and topiramate being recommended. […] Medication overuse with analgesics should be addressed prior to initiating treatment. […] Response to treatment should be assessed after 3 months using headache diaries. […] If there is a good response to treatment, the agent may be continued for a pre-defined period as determined locally (e.g. 12-24 months), before consideration of a treatment holiday. […] If there is recurrence of headache during a treatment holiday, treatment may be re-initiated.

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