Tension-type headaches can usually be soothed using relaxation techniques or over-the-counter painkillers taken at the time of the headache.
More persistent or recurring tension-type headaches can be treated with amitriptyline (see below). If this is not effective, you should be referred to a neurologist (specialist in diseases of the nervous system) or a pain clinic.
Painkillers
Taking a painkiller such as paracetamol usually works well to relieve a tension-type headache. It is best to take a full dose as soon as a headache starts. A second dose can be taken after four hours if necessary.
Taking ibuprofen (an anti-inflammatory painkiller) is an alternative. Anti-inflammatories may be more effective than paracetamol for some people.
Codeine should be used with caution because of the increased chance of causing medicine-overuse headache and addiction. A short course can be used for a severe headache.
As with all medicines, always follow the instructions on the packet.
Prolonged use of painkillers will eventually cause withdrawal headaches, so they should not be taken for more than a few days at a time and should not be taken to prevent a headache, but taken at the time of the headache.
Amitriptyline
The antidepressant amitriptyline can be prescribed to treat chronic (persistent) tension-type headaches. Evidence has shown that this medication significantly reduces the duration and frequency of them.
Occipital nerve stimulation
Occipital nerve stimulation (ONS) is a new treatment for tension-type headaches that are difficult to manage and not treatable with medication.
ONS involves implanting electrodes, an impulse generator and connecting wires under the skin. The electrodes are implanted near the occipital nerve at the base of the head and the impulse generator is implanted somewhere in the body. The patient uses a remote control to deliver electrical impulses to the occipital nerve, with the aim of masking the pain.
However, the National Institute for Health and Clinical Excellence (NICE) has not yet assessed this treatment and its safety and effectiveness is not yet known.
