Should I take prescription drugs for tension headaches?

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

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.

Medical Information

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 Information

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.

These personal stories may help you make your decision.

Wise Health 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.

*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.

Return to the topic Tension Headaches.