Headaches: Should I take prescription medicine for tension headaches?

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 6 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.

First try over-the-counter pain medicines to manage your headaches. These medicines are safe and cost less than prescription medicines. They include:

• Aspirin.
• Ibuprofen (such as Advil or Motrin).
• Naproxen (such as Aleve).
• Acetaminophen (such as Tylenol).

If these medicines don't help, your doctor may prescribe a medicine that you take each day. The doctor may examine you and ask about your symptoms to find out what kind of medicine is right for you.

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

Three types of medicines are used:

• Antidepressants. These include amitriptyline and mirtazapine (Remeron).
• Anticonvulsants. These seizure medicines include divalproex (such as Depakote).
• Antianxiety medicines. One type is buspirone (such as BuSpar).

The antidepressant amitriptyline is used most often. In some cases doctors prescribe barbiturates or narcotics when other medicines haven't worked. But you can get addicted to these medicines.

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.

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

• When you take them each day, the antidepressants amitriptyline and mirtazapine can greatly reduce how often you get tension headaches and how long they last.¹
• The anticonvulsant divalproex can reduce how often you get tension headaches and how long they last.² It also has been shown to be safe to use for a long period of time.
• The antianxiety medicine buspirone can reduce anxiety and how often you get tension headaches.

You'll need to take pills 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.

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. Some research shows that this can help ease headaches.³ But more research is needed.
• 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. Using counseling and antidepressants often works better than if you only take medicine.⁴
• Relaxation exercises. These help you learn how to relax each muscle group. Using these exercises along with antidepressants often works better than if you only take medicine.⁴
• Electrical nerve stimulation. A mild electrical current is used on specific parts of your body to help treat pain.

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.

Your doctor may advise you to take prescription medicine if:

• You have tension headaches for 15 days or more a month.
• Your tension headache lasts 7 days or more.
• You have tried over-the-counter medicines, but they don't help.