Management of Tension-Type Headache

  • Lars Bendtsen
  • Christian Lampl
  • Mohammed Al Jumah
  • Rigmor Jensen
Reference work entry


Management of the acute episode in patients with infrequent tension-type headache (TTH) is often straightforward, but in patients with frequent TTH management is often difficult. Establishment of an accurate diagnosis is important before initiation of any treatment. Nondrug management should always be considered although the scientific basis is limited. Information, reassurance, and identification of trigger factors may be rewarding. EMG biofeedback has a documented effect in TTH, while cognitive-behavioral therapy and relaxation training most likely are effective. Physical therapy and acupuncture may be valuable options for patients with frequent TTH, but there is no robust scientific evidence for efficacy.

Simple analgesics and nonsteroidal anti-inflammatory drugs are recommended for treatment of episodic TTH. Combination analgesics containing caffeine are drugs of second choice. Triptans, muscle relaxants, and opioids should not be used. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine are drugs of second choice. The efficacy of the prophylactic drugs is often limited and treatment may be hampered by side effects.


Relaxation Training Simple Analgesic Tetracyclic Antidepressant Combination Analgesic Great Occipital Nerve Block 


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Copyright information

© Lifting The Burden 2011

Authors and Affiliations

  • Lars Bendtsen
    • 1
  • Christian Lampl
    • 2
  • Mohammed Al Jumah
    • 3
  • Rigmor Jensen
    • 1
  1. 1.Danish Headache Centre and Department of NeurologyGlostrup Hospital, University of CopenhagenGlostrupDenmark
  2. 2.Department of Neurology and Pain MedicineHeadache Center, Konventhospital Barmherzige Brüder LinzLinzAustria
  3. 3.College of MedicineKAIMRC/King Saud Bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia

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