Tension headaches are the most common type of headaches. Their exact cause is unclear, but stress and muscle tension are known triggers. Headache symptoms include mild to moderate dull, aching pain affecting both sides of the head. You may also feel a sensation of a tight band or pressure around the head. The pain and tenderness from a tension headache can also spread to the scalp, neck, and shoulder muscles. Healthy habits and medications can help to manage tension headaches. Please continue reading to find out which are the best medications for tension-type headaches.

How to tell the difference between tension-type headaches and migraine headaches?

It can be difficult to tell the difference between tension-type headaches and migraine headaches. Frequent episodic tension-type headaches are sometimes accompanied by migraine symptoms.

One way to tell the difference between a tension-type headache versus migraine is that the dull, aching pain associated with tension headaches tends to affect both sides of the head, while a migraine generally causes severe throbbing pain that only occurs on one side of the head, or one side is markedly worse than the other. Other symptoms like visual disturbances, nausea, vomiting, and worsening headache pain with activity are the hallmark symptoms of migraines. Also, tension-type headaches are less likely to be associated with noise and light sensitivity, but it can happen in some rare cases.

Your doctor may diagnose you with an episodic tension-type headache if you have headache pain lasting for 30 minutes to a week. Frequent episodic tension-type headache takes place less than 15 days a month for at least 3 months. If the frequency increases to 15 or more days per month for at least 3 months, it is considered chronic headache pain or chronic tension-type headaches.

What medications are used to treat chronic tension-type headaches?

The following medications can be used to treat tension headaches:

Medications for acute treatment

These drugs provide quick relief from head pain caused by tension headaches. They can effectively relieve mild to moderate pain.

OTC pain relievers

Medications such as acetaminophen, aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Aleve) are available without a doctor’s prescription and are widely used to treat minor aches and pains. They can be used to relieve pain associated with tension-type headaches. However, repeated use of these simple pain relievers can cause more severe headaches called rebound headaches or medication overuse headaches.

Combination medications

Acetaminophen, aspirin, or both are frequently combined with other ingredients like caffeine in a single pill. These are usually available without a prescription. For example, Excedrin contains aspirin, acetaminophen, and caffeine. This type of combination pain medicine can be more effective for severe pain than a single-ingredient pain reliever. Again, taking medication for more than 15 days in a month can lead to a rebound headache or medication overuse headache.

Triptans

These are migraine medications that may benefit people with severe headaches caused by both migraine and tension-type headaches. Examples of triptans include sumatriptan (Imitrex), eletriptan (Relpax), naratriptan (Amerge), frovatriptan (Frova), almotriptan (Axert), zolmitriptan (Zomig), and rizatriptan (Maxalt). Triptans come in pill form, nasal sprays, and injections. Combinations of triptans and nonsteroidal anti-inflammatory drugs are also available for severe headache treatment (for example, sumatriptan and naproxen in Treximet).

Medications for the prevention of tension-type headaches

Medications can be prescribed to people with frequent tension-type headaches to help prevent tension headaches. They are usually given to people for whom pain relievers do not provide adequate pain relief. However, it can take several weeks to get the full benefits of these drugs. Below are some examples of preventive medications to reduce the frequency and severity of headaches.

Antidepressants

Your doctor may prescribe tricyclic antidepressants such as amitriptyline (Elavil) and protriptyline (Vivactil) or other antidepressants such as venlafaxine (Effexor XR) and mirtazapine (Remeron) to prevent chronic tension-type headache. Taking certain pain relievers while on preventive medications can interfere with how well they work. If you are on an antidepressant for the prevention of frequent tension headaches, check with your healthcare provider about how often you can take pain relievers for severe pain.

Beta blockers

For those with severe, chronic tension headaches, a beta blocker such as propranolol may be prescribed in combination with one of the tricyclic antidepressants to prevent the severity and frequency of tension-type headaches.

Anticonvulsants

Anticonvulsant medications like gabapentin (Neurontin) and topiramate (Topamax) are sometimes prescribed to prevent tension-type headaches. However, more research is needed to confirm their efficacy in treating chronic pain.

Muscle relaxants

Muscle relaxants like baclofen and tizanidine may relieve muscle tension and prevent tension headaches. However, there is limited evidence supporting their efficacy.

Botox injections

Botulinum toxin A (Botox) injections have been used to treat chronic migraines, but their usefulness in a headache pattern such as cluster headache or tension-type headache is unproven.

What is the fastest way to relieve a tension headache?

The fastest way to relieve tension headache symptoms is to take an over-the-counter pain reliever such as ibuprofen or naproxen; a combination medication that contains aspirin, acetaminophen, and caffeine; or a prescription headache medication such as a triptan if you have mixed symptoms of migraine and tension headaches.

What is better for a tension headache, Tylenol or ibuprofen?

Both Tylenol (acetaminophen) and ibuprofen (Advil, Motrin) can provide relief from tension headaches. Some people find ibuprofen works better, but your experience may be different. Keep in mind that acetaminophen may not be safe for you if you have liver problems. However, it is safe to take during pregnancy. On the other hand, ibuprofen should be used with caution or avoided if you have a history of stomach ulcers, high blood pressure, heart disease, a clotting disorder, or kidney disease.

Is ibuprofen or Excedrin better for a tension-type headache?

Excedrin is a brand name product that contains a combination of aspirin, acetaminophen, and caffeine. Ibuprofen (Advil, Motrin) is a single-ingredient NSAID (nonsteroidal anti-inflammatory drug). Many people find that a combination medication such as Excedrin works better for tension headaches. However, remember, overuse of over-the-counter medications can result in medication overuse headaches. If you have chronic headaches and find yourself taking OTC painkillers more than 15 days a month, seek medical attention. Your doctor may order blood work and imaging tests to see if there is some other medical problem causing headache pain. Once they make a proper diagnosis, they will discuss treatment options.

What is the best painkiller for tension headaches?

The best painkiller for tension headaches is the one that works for you and causes minimal side effects. Keep in mind that medications may only be necessary for severe cases. Lifestyle changes can provide relief from most headaches that are mild.

What are some natural non-drug treatments for headache pain?

Some of the non-drug, natural treatments for tension headaches include:

Rest.
Ice packs.
A long, hot shower.
Application of heat or ice to sore muscles.

Strategies to prevent headaches include:

References:

https://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/syc-20353977
https://www.health.harvard.edu/blog/stopping-the-vicious-cycle-of-rebound-headaches-2019110718180#:
https://my.clevelandclinic.org/health/treatments/24998-triptans
https://pubmed.ncbi.nlm.nih.gov/12696998/
https://www.ucsfhealth.org/conditions/tension-headaches

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