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decision pointShould I take prescription drugs for tension headaches?

Prescription headache drugs can have side effects that range from mild to severe. But these drugs can also very effectively stop or prevent tension headache symptoms, which will greatly improve your quality of life.

Consider the following when making your decision:

  • For occasional mild to moderate tension headaches, taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, may be all you need to relieve your symptoms. These drugs are safe and have few side effects. But avoid using nonprescription drugs more than 3 times a week, because you may get rebound headaches.
  • For chronic tension headaches that affect daily living, prescription drugs can relieve your symptoms and restore your ability to function. You will lose less time from work or school and improve the quality of your life.
  • Some pain relievers that are used to treat tension headaches can become addictive, have serious side effects, and interact poorly with other drugs that you are taking. As with NSAIDs, you may also suffer rebound headaches if you take pain relievers too often.
  • Taking certain drugs, such as antidepressants, every day may help prevent frequent and severe chronic tension headaches.

What is a tension headache?

A tension headache causes constant, steady ache and tightness around your forehead, both temples, or the back of your head and neck. Usually, pain from a tension headache is mild to moderate. It doesn't usually keep you from doing your daily tasks. But the pain can sometimes be severe or continuous and disruptive.

These headaches are common and tend to come back, especially when you are under stress. Tension headaches can last anywhere from 30 minutes to several days.

Unlike other headaches (such as migraines), tension headaches do not usually cause nausea, vomiting, or sensitivity to both light and noise (although sensitivity to one or the other is possible), and they are usually not disabling.

If you have tension headaches for 15 days or more a month, you may have chronic tension headaches.

What causes tension headaches?

The cause of tension headaches is not clear. Experts believe there may be more than one factor that causes tension headaches. In the past, doctors believed that tension or spasms in the muscles of the neck, face, jaw, head, or scalp played a role. Now they think that a change in brain chemicals may also help cause tension headaches.

What is the treatment for tension headaches?

Treatment for tension headaches may include nonprescription pain relievers or prescription drugs (such as antidepressants). You may try other therapies, including stress management or biofeedback, to treat or prevent tension headaches.

How effective are prescription drugs?

Antidepressants and anticonvulsants are drugs that are used to treat chronic or severe tension headaches. Amitriptyline, a tricyclic antidepressant, has been proven to greatly reduce how often you get tension headaches and how long they last. The anticonvulsant divalproex sodium (for example, Depakote) is also an effective treatment for chronic tension headaches.

What are the side effects of these drugs?

Side effects depend upon the type of drugs you are taking. Overusing pain relievers may lead to rebound headaches. If you decide to take drugs for tension headaches, be sure to take them only as directed by your doctor. Doctors prescribe antidepressants or anticonvulsants for tension headaches more often than other prescription drugs.

One of the most common antidepressants that doctors prescribe to treat tension headaches is amitriptyline, a tricyclic antidepressant. Generally, side effects of antidepressants include dry mouth, constipation, blurred vision, inability to urinate (urinary retention), weight gain, and problems with low blood pressure when you stand up. Other antidepressants can cause problems with sexual performance or ability, and some can lead to potentially serious side effects when they are combined with foods and other drugs. If you want to try an antidepressant to treat chronic tension headaches, talk with your doctor about which antidepressant is right for you.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

  • An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.
  • A warning on anticonvulsants and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor.

If you need more information, see the topic Tension Headaches.

Your choices are:

  • Take nonprescription pain relievers such as aspirin or ibuprofen to control symptoms of tension headaches as they occur.
  • Take prescription drugs such as antidepressants every day to reduce the frequency and severity of chronic tension headaches.

The decision about whether to take prescription drugs to treat tension headaches takes into account your personal feelings and the medical facts.

Deciding about prescription drugs for tension headaches
Reasons to take prescription drugs Reasons not to take prescription drugs
  • You have moderate to severe headaches that affect your daily activities.
  • You have frequent or chronic tension headaches.
  • Your symptoms get in the way of your ability to function and you miss school or work because of chronic tension headaches.
  • You have tried taking nonprescription pain relievers such as aspirin or ibuprofen, but they do not relieve your symptoms.
  • Your tension headaches are related to anxiety and depression, and antidepressants will help relieve symptoms of your combined conditions.
  • You have tried numerous stress management therapies but none has helped reduce how often your tension headaches occur.

Are there other reasons you might want to take prescription drugs?

  • You have mild to moderate tension headaches that are not disabling.
  • You get tension headaches only once in awhile.
  • Your symptoms can be controlled by nonprescription pain relievers such as aspirin or ibuprofen.
  • You cannot tolerate the side effects of drugs (such as blurred vision or constipation caused by antidepressants, or intoxication or addiction caused by narcotics).
  • Other drugs that you are taking for additional health conditions interact poorly with drugs for tension headaches.
  • You believe your tension headaches are related to stress, and you want to try stress management therapies (such as biofeedback or relaxation exercises) before trying drugs.
  • You are pregnant or nursing a baby.

Are there other reasons you might not want to take prescription drugs?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking prescription drugs for tension headaches. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I get tension headaches more than 15 times a month. Yes No Unsure
I get tension headaches, more than 1 a month but less than 15 a month, and more than 12 in a year. Yes No Unsure
I get infrequent headaches, maybe 1 a month, but no more than 12 in a year. Yes No Unsure
I think I might be depressed or anxious. Yes No Unsure
A stressful event usually leads to my tension headache. Yes No Unsure
I will work with my doctor to develop the best treatment plan for my tension headaches, knowing that it could take some time to identify the right drug for me. Yes No Unsure
I may be taking too many pain relievers to treat my headaches. Yes No Unsure
I think I can tolerate the side effects of prescription drugs. Yes No Unsure
I have tried stress management therapies such as biofeedback, relaxation exercises, yoga, or meditation. Yes No NA*
I understand that some pain relievers can become addictive. Yes No NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to take or not take prescription drugs for tension headaches.

Check the box below that represents your overall impression about your decision.

Leaning toward taking prescription drugs for tension headaches

 

Leaning toward NOT taking prescription drugs for tension headaches

         
Author Dana L. Rowett
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Seymour Diamond, MD - Neurology
Last Updated July 22, 2009

WebMD Medical Reference from Healthwise

Last Updated: July 22, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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