Medications for tension headaches
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Acute Medications for Tension-Type Headaches: Ibuprofen, Paracetamol, and Simple Analgesics
For the acute treatment of episodic tension-type headaches, over-the-counter medications like ibuprofen and paracetamol (acetaminophen) are commonly used and recommended. Both drugs are more effective than placebo in relieving pain, with ibuprofen showing slightly better efficacy at two hours, while paracetamol may work faster within the first hour and is associated with a lower need for rescue medication. However, there is no significant difference in overall effectiveness between the two drugs, and both are considered safe, with adverse event rates similar to placebo. For individuals at higher risk of gastrointestinal or kidney problems, paracetamol may be preferred over ibuprofen. Fixed-dose combinations of ibuprofen and paracetamol can provide faster and longer-lasting pain relief with lower doses of each drug, potentially enhancing the analgesic effect through additive mechanisms. Other simple analgesics like diclofenac-K and ketoprofen are also effective, with ibuprofen and diclofenac-K ranking as the most effective and safe options for acute treatment based on recent evidence. All these medications are generally well-tolerated, with adverse event rates comparable to placebo, except for ketoprofen, which may have a higher rate of side effects 24568.
Preventive Medications for Chronic Tension-Type Headaches: Tricyclic Antidepressants and Alternatives
For people with frequent or chronic tension-type headaches, preventive medications are sometimes needed. Tricyclic antidepressants (TCAs), such as amitriptyline, are the most studied and effective preventive option. TCAs reduce headache frequency and the need for painkillers more effectively than placebo and are superior to selective serotonin reuptake inhibitors (SSRIs) and buspirone. However, TCAs and behavioral therapies (like stress management) are similarly effective, and combining both approaches may lead to better outcomes than using either alone. Tetracyclic antidepressants do not appear to be effective for chronic tension-type headaches. SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) are generally not more effective than placebo or TCAs for prevention, and there is no strong evidence to support their use for this purpose. TCAs may cause more side effects than SSRIs or SNRIs, but these do not usually lead to more people stopping the medication 137810.
Global Availability and Access to Tension Headache Medications
Most countries have good access to common acute and preventive medications for tension-type headaches, such as simple analgesics and tricyclic antidepressants. However, access to newer or less common treatments can vary widely depending on the country and healthcare system .
Conclusion
For acute tension-type headaches, simple analgesics like ibuprofen and paracetamol are effective, safe, and widely available, with ibuprofen and diclofenac-K being the most effective options. For chronic or frequent tension-type headaches, tricyclic antidepressants are the best-studied preventive medications, and combining them with behavioral therapies may offer additional benefits. SSRIs and SNRIs are not recommended for prevention based on current evidence. Access to these medications is generally good worldwide, but disparities remain for some treatments.
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