You can manage tension headaches by taking pain relievers that you can buy without a prescription, such as nonsteroidal anti-inflammatory drugs (NSAIDs) (for example, aspirin or ibuprofen). If you have chronic or severe tension headaches, you may need to take a prescription drug (such as an antidepressant) every day to reduce the pain and frequency of your headaches. You may also try complementary therapies (such as acupuncture, biofeedback, or meditation), to help lower stress, which may help reduce or prevent your headaches.

Initial treatment

When first treating tension headaches pain, you may try taking nonprescription drugs. These drugs usually have fewer side effects than prescription pain relievers. Also, you may be able to prevent or reduce tension headaches by learning what causes your headaches, such as stress or anxiety, and trying to avoid those triggers. For more information, see:

Identifying and avoiding tension headache triggers

Nonprescription drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, usually reduce the pain you get with a tension headache. But try to avoid taking nonprescription drugs more than 3 times a week, because you may get rebound headaches. Rebound headaches are different from tension headaches. They are usually triggered after pain medicine has worn off, prompting you to take another dose. Eventually, you get a headache whenever you stop taking the medicine.

Prescription drugs. If nonprescription drugs do not relieve your headache, your doctor may prescribe stronger medicine to treat your pain. You may be prescribed:

• Antidepressants such as mirtazapine (Remeron) and the tricyclic antidepressant amitriptyline. When taken daily, these medicines can help reduce how often tension headaches occur and how long they last.¹
• Seizure medicines or antianxiety drugs. These medicines are not often used to treat tension headaches.

In some cases your doctor may prescribe drugs such as barbiturates or narcotics when other drugs are ineffective. But these drugs can be habit-forming and should be used sparingly.

Should I take prescription drugs for tension headaches?

Stress management. Managing stress, anxiety, or depression may help reduce the frequency of tension headaches. The best approach to managing chronic tension headaches may be a combination of drugs and stress management therapies. Nonmedication methods for reducing stress may include:

• Biofeedback, a relaxation method to help you learn to control a body function that is not normally under conscious control, such as muscle tension.
• A relaxation exercise during which you focus on relaxing each muscle group. Relaxation exercises can help with tension headaches. When relaxation exercises and antidepressants are used together as treatment, the results are even better.³
• Acupuncture, which involves putting very thin needles into the skin at certain points on the body to produce energy flow along the body's meridians. Evidence specifically for tension headaches shows that acupuncture is no better than sham acupuncture (when needles are put into the skin, but not at the right points).⁴
• Transcutaneous electrical nerve stimulation (TENS), which may help reduce pain.
• Cognitive-behavioral therapy or problem-solving therapy during counseling sessions. Cognitive-behavioral therapy and problem-solving therapy can help with tension headaches. When cognitive-behavioral therapy or problem-solving therapy and antidepressants are used together as treatment, the results are even better.³
• Yoga.
• Meditation.

Ongoing treatment