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Headaches: Should I Take Prescription Medicine for Tension Headaches?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Take a daily prescription medicine to help prevent your tension headaches.
  • Don't take a daily prescription medicine. Instead, treat your tension headaches only when you have them.

Key points to remember

  • If your tension headaches are mild to moderate, first try an over-the-counter pain medicine, such as aspirin, ibuprofen, naproxen, or acetaminophen.
  • If nonprescription medicines don't work to stop your headaches, or if you take them more than 3 times a week or have a headache more than 15 days a month, your doctor may recommend you take a prescription medicine every day to help prevent headaches.
  • Even with treatment, you may still get some tension headaches. But when you do get them, they may not be as bad or last as long.
  • There are other things you can try besides daily medicine. For example, you could use cognitive-behavioral therapy or biofeedback.
  • The medicine you take may cause side effects. Some of these side effects may last for a few weeks or for as long as you take the medicine.
FAQs

What is a tension headache?

There are different kinds of headaches. Most people get tension headaches. When you have a tension headache, you may feel a constant ache, tightness, and pressure around your forehead, temples, or the back of your head and neck. It may feel like your head is in a vise.

Tension headaches usually cause mild to moderate pain. Most of the time, they aren't bad enough to stop you from doing your daily tasks. But some people have very bad headaches that last a long time. These headaches can disrupt your life.

Tension headaches tend to come back, especially when you're under stress. They can last from 30 minutes to several days.

If you have tension headaches for 15 days or more a month for 3 months, you may have chronic tension headaches. Some people who have chronic headaches also have anxiety and depression.

The cause of tension headaches is not clear. Doctors used to think that these headaches were caused by tension or spasms in the muscles of the neck, face, jaw, or head. Now they think that a change in brain chemicals may also cause these headaches.

How are tension headaches treated?

First try over-the-counter pain medicines to manage your headaches. Be safe with medicines. Read and follow all instructions on the label.

Nonprescription medicines for headaches include:

  • Acetaminophen (such as Tylenol).
  • Aspirin (such as Bayer).
  • Ibuprofen (such as Advil).
  • Naproxen (such as Aleve).
  • Combination medicine that includes aspirin, acetaminophen, and caffeine (such as Excedrin).

If the nonprescription medicines above don't work to stop your headaches, or if you take them more than 3 times a week or have a headache more than 15 days a month, your doctor may recommend you take a prescription medicine every day to help prevent headaches.

Your doctor may also suggest ways to reduce stress and anxiety as a way to manage your headaches.

What prescription medicines can you take to help prevent tension headaches?

Your doctor may have you try one of more of the following medicines to help prevent your headaches:

  • Antidepressants, such as amitriptyline.
  • Seizure medicines, such as gabapentin, topiramate, and valproate.
  • Antianxiety medicines, such as buspirone.

Often the best way to treat chronic tension headaches is to use medicine along with treatments that reduce stress and anxiety, such as cognitive-behavioral therapy.

How well do these medicines work?

Even with treatment, you may still get some tension headaches. But studies have shown that:

  • When you take them each day, antidepressants like amitriptyline can reduce how often you get tension headaches and how bad they get.1
  • Seizure medicines may be able to reduce how often you get tension headaches and how long they last.2
  • The medicine tizanidine may help prevent tension headaches.3
  • The antianxiety medicine buspirone may be able to reduce how often you get tension headaches by reducing anxiety.

What can you expect if you take prescription medicine for tension headaches?

You'll need to take medicine every day, even when you don't have a headache.

If you don't feel better after a few weeks of taking the medicine, talk to your doctor. You may need to try several different medicines to find one that works for you.

The medicine can cause side effects. Some of these side effects may last for a few weeks or for as long as you take the medicine. You may need to decide which bothers you more, the side effects of the medicine or your headaches.

Common side effects include:

  • Dry mouth.
  • Constipation.
  • Blurred vision.
  • Inability to urinate.
  • Weight gain.
  • Low blood pressure when you stand up quickly.

Serious side effects can also happen. When taken during pregnancy, anticonvulsants can cause birth defects.

What else can you do to manage your tension headaches?

Some people find other ways to manage headaches besides taking medicine. These include:

  • Acupuncture. Tiny needles are put into certain points on your skin to relieve pain. Current evidence shows that acupuncture can help prevent tension headaches.4
  • Biofeedback. With this treatment, you can learn to control a body function that is not normally under your conscious control, such as breathing or muscle tension.
  • Cognitive-behavioral therapy or problem-solving therapy. This kind of counseling can help you reduce stress and anxiety.
  • Relaxation exercises. These help you learn how to relax each muscle group.
  • Electrical nerve stimulation. A mild electrical current is used on specific parts of your body to help treat pain.
  • Peppermint oil. There is some evidence that peppermint oil rubbed on the temples or on the tight muscles in the head, neck, and shoulders may help relieve tension headaches.

Here are some things you can do at home:

  • Figure out what may cause your tension headaches. Is it stress, anxiety, fatigue, hunger, anger, poor posture, or eye or muscle strain? Are you doing too much? It may help to keep a headache diary to track how often you have tension headaches, how painful they are, and what you think might be causing them.
  • Get plenty of exercise, eat healthy foods, and get enough sleep.
  • Use good posture to avoid muscle tension.

Why might your doctor recommend prescription medicine to help prevent your tension headaches?

Your doctor may advise you to take prescription medicine if:

  • You have tension headaches on 15 or more days a month.
  • You use over-the-counter medicines to stop a headache more than 3 times a week.
  • Your tension headache lasts 7 days or more.
  • You have tried over-the-counter medicines, but they don't help.

2. Compare your options

Take prescription medicine to help prevent tension headaches Don't take prescription medicine to help prevent your headaches
What is usually involved?
  • You take medicine every day, even if you don't have a headache.
  • You may still try over-the-counter medicines to stop headaches that you do get.
  • You may also use other treatments that help to reduce stress and anxiety.
  • You still try to avoid things that may trigger your tension headaches, such as stress, anxiety, and muscle strain.
  • You may try over-the-counter medicines to manage your headaches.
  • You may also use other treatments that help to reduce stress and anxiety.
  • You try to avoid things that may trigger your tension headaches, such as stress, anxiety, and muscle strain.
What are the benefits?
  • Benefits include:
    • Fewer or no tension headaches.
    • Shorter headaches.
    • Headaches that aren't as severe.
  • If your symptoms don't improve with other medicines, counseling, or home treatment, you can decide later to try prescription medicine.
  • You avoid the side effects of the medicine.
  • You don't have to take medicine every day.
What are the risks and side effects?
  • Possible side effects include:
    • Dry mouth.
    • Constipation.
    • Blurred vision.
    • Inability to urinate.
    • Weight gain.
    • Low blood pressure when you stand up quickly.
  • You continue to get tension headaches.
  • If your symptoms are severe, you may miss several days of work or school.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about taking medicines for tension headaches

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My job requires me to spend a lot of time in front of a computer screen, and my eyes are sore at the end of most days. I also have a lot of stress in my life right now. I am getting frequent tension headaches, but an aspirin usually relieves the pain. I'm keeping a headache diary to see how often I get these headaches. I am going to try putting a filter on my computer screen and taking frequent breaks. I've also signed up for a yoga class to help me relax. If I continue to have tension headaches, I will take my headache diary to my doctor and see if I need stronger medicines."

— Joyce, age 34

"Recently I've been getting tension headaches almost daily. I take naproxen and sometimes aspirin whenever I get a headache. My headaches go away for awhile but then come back within a couple of hours after I take these pain relievers. My doctor said I might be getting rebound headaches from taking too many pain relievers. She thinks I should try taking prescription medicine every day to prevent my headaches. I think I will take her advice and see if I can get these headaches under control."

— John, age 45

"I have had a lot of changes in my life recently. I started getting headaches around the time we moved to a new town. My mom thinks they are related to stress and will go away when I feel comfortable at my new home and school. Sometimes I need to take an ibuprofen for the headache, but not always. I am learning how to do relaxation exercises at a class I'm taking, and this seems to help. My parents talked about it and decided to wait for a month to see if the headaches go away before taking me to the doctor."

— Leslie, age 14

"I have been getting tension headaches for more than 7 months. I decided to start keeping a diary of how often I get them to try to identify any triggers. So far, it looks like I get headaches around 20 days out of every month, but I'm not sure why. While I don't miss a lot of time away from work, I do think my productivity is suffering. I've tried biofeedback to see if I could reduce stress, but that hasn't helped. My doctor thinks it is time for me to try an antidepressant to prevent tension headaches from occurring. I think I'll give that a try."

— Jennifer, age 35

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take prescription medicine for tension headaches

Reasons not to take prescription medicine for tension headaches

I'm willing to take medicine every day, because I think it will help ease my tension headaches.

I want to take medicine only when I have a headache.

More important
Equally important
More important

I don't think the side effects of the medicine could be as bad as my tension headaches.

I think the side effects of the medicine would bother me more than my headaches.

More important
Equally important
More important

My tension headaches are affecting my work and relationships with friends and family.

My tension headaches aren't really affecting my work and relationships with friends and family.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking prescription medicine for tension headaches

NOT taking prescription medicine for tension headaches

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. If I only get tension headaches every now and then, and if they don't bother me too much, I should take prescription medicine every day to treat them.

  • True
  • False
  • I'm not sure
That's right. Doctors recommend that you first try an over-the-counter pain medicine, such as aspirin, ibuprofen, naproxen, or acetaminophen, before you try a prescription medicine.

2. I may still get tension headaches, even though I'm taking medicine to prevent them.

  • True
  • False
  • I'm not sure
That's right. You may still get some tension headaches. But when you do get them, they may not be as bad or last as long.

3. If I don't want to take medicine to treat my tension headaches, I can try other kinds of treatment that may help me feel better.

  • True
  • False
  • I'm not sure
That's right. There are other things you can try that don't involve taking medicine every day, such as using cognitive-behavioral therapy and biofeedback.

Decide what's next

1. Do you understand the options available to you?

  • Yes
  • No

2. Are you clear about which benefits and side effects matter most to you?

  • Yes
  • No

3. Do you have enough support and advice from others to make a choice?

  • Yes
  • No

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits and References
Credits
ByHealthwise Staff
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
Specialist Medical ReviewerAndrew Swan, MD, CCFP, FCFP - Family Medicine

References
Citations
  1. Jackson JL, et al. (2010). Tricyclic antidepressants and headaches: Systematic review and meta-analysis. BMJ. Published online October 20, 2010 (doi:10.1136/bmj.c5222).

  2. Fumal A, Schoenen J (2008). Tension-type headache: Current research and clinical management. Lancet Neurology, 7(1): 70–83.

  3. Loder E, Rizzoli P (2008). Tension-type headache. BMJ, 336(7635): 88–92.

  4. Linde K, et al. (2009). Acupuncture for tension-type headache. Cochrane Database of Systematic Reviews (1).


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