Tension-type headache in adults: Acute treatment
- Frederick R Taylor, MD
Frederick R Taylor, MD
- Professor of Neurology
- University of Minnesota
Tension-type headache (TTH) is the most ubiquitous headache in the general population, and is one of the most common reasons why over-the-counter analgesics are purchased. Despite the high frequency of TTH and the total disability society bears due to this primary headache, treatment has been driven more by anecdote and word-of-mouth consensus than by therapeutic trials . This situation is perhaps due to the typically mild nature of TTH, such that patients with this type of headache usually self-diagnose and self-treat unless they have concurrent migraine or develop chronic TTH.
Understanding the pathophysiology of TTH is likely the key to formulating a mechanistically sound, optimum treatment plan. Unfortunately, the scientific understanding of TTH lags that of migraine, and the postulated TTH mechanisms have produced limited treatment leads. (See "Tension-type headache in adults: Pathophysiology, clinical features, and diagnosis", section on 'Pathophysiology'.)
This topic will review the acute treatment of TTH in adults. Preventive treatment of TTH is reviewed elsewhere. (See "Tension-type headache in adults: Preventive treatment".)
Other aspects of TTH are discussed separately. (See "Tension-type headache in adults: Pathophysiology, clinical features, and diagnosis".)
APPROACH TO TREATMENT
The acute or abortive (symptomatic) therapy of TTH ranges from nonpharmacologic therapies to simple and combination analgesic medications. In most cases, the treatment of TTH is largely self-directed using over-the-counter medications without any input from a medical provider. Some general principles are relevant to the pharmacologic therapy of TTH:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- APPROACH TO TREATMENT
- Judging the success of acute treatment
- SIMPLE ANALGESICS
- Nonsteroidal anti-inflammatory drugs
- Acetaminophen and aspirin
- Choice of initial therapy
- OTHER ACUTE INTERVENTIONS
- Combination analgesics containing caffeine
- Combination analgesics containing butalbital and codeine
- Parenteral treatments
- Muscle relaxants
- TREATMENT FAILURES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS