Pharmacotherapy of tension-type headache (TTH)

Abstract

In this article, we review the existing literature on medications and make practical recommendations based on the evidence of their efficacy. We review both abortive and prophylactic medications (such as tricyclic antidepressants and non-steroidal anti-inflammatory drugs, respectively). Both are used for chronic TTH and abortive medications only for infrequent episodic TTH (ETTH). As far as frequent ETTH, abortive medications are used and prophylactic medications often but not systematically. We comment and advise on general therapeutic principles of TTH management.

Cefalea tensional

“…En varios estudios frente a placebo redujo el índice de cefalea hasta un 30% (79). El tratamiento inicial es de 10 mg en una única dosis nocturna (por su efecto sedante), con un incremento de dosis paulatino (10 mg/semana) hasta una dosis recomendable de 2575 mg. El incremento de dosis gradual evita los efectos secundarios, que son dosis dependientes (30,81). Se deben usar dosis bajas en ancianos y niños (p.…”

Posttraumatic Headache

“…NSAIDs are effective for migraine, tension-type headache, and cervicogenic headache. 44,[57][58][59] The specific NSAID agent is not especially important, although naproxen and ibuprofen are the most widely used. Naproxen, as a long-acting agent, may be especially favorable.…”

“…59 Other prophylactic agents that may be helpful for tension-type headache are tizanidine, mirtazapine, and topiramate.…”

The Sexagenarian with Unrelenting Headache

“…Moreover, nonpharmacologic options must be given consideration. The scarcity of therapeutic research in TTH leaves the clinician with few evidence‐based options 20 …”

“…The evidence for their efficacy is found in a limited number of studies 21,22 . Most studies show either a limited number of patients or only some parameters reaching significance or no placebo control 20 . The recommended regimen for amitriptyline is once daily, at bedtime, or occasionally twice a day if the total daily dosage exceeds 100 mg. Other drugs in the class that can be used include clomipramine, nortriptyline, doxepin, and mirtazapine all at similar doses.…”