Drug Treatment for Episodic and Chronic Tension-Type Headache

  • Lars BendtsenEmail author
  • Sait Ashina
Part of the Headache book series (HEAD)


Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Simple analgesics are recommended for treatment of episodic tension-type headache. There is evidence for efficacy of ibuprofen 200–800 mg, aspirin 500–1000 mg, paracetamol 1000 mg, ketoprofen 25 mg, naproxen 375–550 mg and diclofenac 12.5–100 mg. Combinations containing caffeine are recommended as drugs of second choice. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache (MOH). Triptans are not indicated in the management of tension-type headache. The tricyclic antidepressant amitriptyline 30–75 mg/day is drug of first choice for the prophylactic treatment of chronic tension-type headache. Mirtazapine 15–30 mg/day and venlafaxine 150 mg/day are drugs of second choice.


Antidepressants Management Prophylaxis Tension-type headache 


Declaration of Interests

Lars Bendtsen has received honoraria for lectures from MSD, Allergan and Pfizer, serves on the scientific advisory board for Berlin-Chemie, has been a consultant to Reckitt Benckiser and been on Reckitt Benckiser speaker panels and has been principal investigator for Convergence Pharmaceuticals.

Sait Ashina received honoraria for lecturing from Allergan, Nautilus Neurosciences and NeurogesX and served as a consultant for Depomed.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of NeurologyDanish Headache Centre, Glostrup Hospital, University of CopenhagenCopenhagenDenmark
  2. 2.Department of Neurology, Headache ProgramMount Sinai Beth Israel, Icahn School of Medicine at Mount SinaiNew YorkUSA

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