The most commonly used medications to treat chronic tension-type headaches and frequent episodic tension-type headaches are tricyclic antidepressants, beta-blockers, and tizanidine Because active headache diaries are relatively new, many of these medications were studied based upon physician diagnosis only. Therefore, one can expect that there was significant contamination of the patient population with migraine patients.
The most widely used and studied tricyclic antidepressant is amitriptyline. Sedation and weight gain are the most common side effects that limit its use. Nortriptyline has fewer side effects but may be less effective. The newer class of medications SNRIs (Selective Serotonin and Norepinephrine Reuptake Inhibitors) - provide a relative balance (compared to SSRIs (Selective Serotonin Reuptake Inhibitor)) and are easily to tolerate compared to amitriptyline. Therefore, duloxetine is commonly used for those patients that are intolerant to amitriptylene.
The next class of medications used are beta-blockers. Propranolol, metoprolol, atenolol, and pindolol have all been used. If you get the side effect of low blood pressure then patients will commonly complaint of fatigue, light-headedness or dizziness.
Tizanidine has also been used for chronic tension type headaches. It is less frequently used than the tricyclics or beta-blockers. Sedation is a common dose limiting side effect.
In the past SSRI’s (Selective Serotonin Reuptake Inhibitor) have been popular. This class of medication is much easier to tolerate than the tricyclic antidepressants. The best-studied medication of this class is Prozac® (fluoxetine). Prozac® has the advantage of also being available in a once-weekly dose. Over time, the use of SSRIs have been replaced by the SNRIs.
For patients who do not respond to any of the above treatments, both Neurontin® and Botulinum toxin (Botox®) are becoming popular. Neurontin® is the safest of all the oral medications used for this condition and may be the best choice if a patient is taking other medications. Botulinum toxin has even fewer side effects, but costs substantially more and is rarely covered by insurance companies for the treatment of tension headaches. Another disadvantage of Botox for some patients is that treatment must be repeated every 12 weeks.
This educational content was written by Brian D. Loftus, MD, a neurologist, headache specialist and a developer of iHeadache. The science and study of headaces is changing rapidly. If there is information on this page that is incorrect or needs revision, please contact us.
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