Pharmacological and nonpharmacological treatment of tension-type headache
DOI:
https://doi.org/10.12775/QS.2025.41.60212Keywords
headache, non-pharmacological treatment, tension-type headache, acupuncture, TENSAbstract
Introduction and purpose: Tension-type headache (TTH) is known to be the most prevalent form of primary headache with a 1-year prevalence of about 26%. About 3 billion people experienced tension type headaches or migraine in 2016. Prevalence rate appears to be highest at 35-39 years of age. Some patients suffer from chronic tension-type headaches (CTTH) when the pain appears during 15 days of a month for 3 months continuously. This review aims to summarize current knowledge in pharmacological and non-pharmacological treatment of this condition.
Material and methods: Medical databases like PubMed and Google Scholar were searched for scientific papers on the pharmacological and non-pharmacological interventions in tension-type headache. These were analyzed and summarized in this review.
State of knowledge: Pharmacological treatment of acute tension-type headache is based on non-steroidal anti-inflammatory drugs (NSAIDs), especially ibuprofen, and acetaminophen. For preventive treatment amitriptyline, opipramol and selective serotonin reuptake inhibitors are used. Among non-pharmacological treatments we distinguish physical methods like acupuncture, myofascial trigger points therapy, extracorporeal shockwave therapy, physical exercises (aerobic and strengthening), Transcutaneous Electrical Nerve Stimulation and yoga. Psychological therapy is an additional procedure for reducing the pain.
Conclusion: However there are many possibilities of treatment both pharmacological and non-pharmacological, it is still a wide area to investigate.
References
1. Gajewski P, Narbutt J, Szczeklik A, editors. Szczeklik’s internal medicine 2023: Textbook of internal diseases. 1st ed. Krakow (PL): Practical Medicine; 2023.
2. Liberski PP, Kozubski W, Moryś J, editors. Neurology: A textbook for medical students. Volumes 1-2. Warsaw (PL): PZWL; 2013.
3. GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2018;17(11):954-976. doi:10.1016/S1474-4422(18)30322-3
4. Onan D, Younis S, Wellsgatnik WD, et al. Debate: differences and similarities between tension-type headache and migraine. The journal of headache and pain. 2023;24(1):92. doi:10.1186/s10194-023-01614-0
5. Loder E, Rizzoli P. Tension-type headache. BMJ (Clinical research ed). 2008;336(7635):88-92. doi:10.1136/bmj.39412.705868.AD
6. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA. 1998;279(5):381-383. doi:10.1001/jama.279.5.381
7. Ghadiri-Sani M, Silver N. Headache (chronic tension-type). BMJ clinical evidence. 2016;2016.
8. Ashina S, Bendtsen L, Ashina M. Pathophysiology of tension-type headache. Current pain and headache reports. 2005;9(6):415-422. doi:10.1007/s11916-005-0021-8
9. Spierings EL, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine versus tension-type headache. Headache. 2001;41(6):554-558. doi:10.1046/j.1526-4610.2001.041006554.x
10. Monteith TS, Oshinsky ML. Tension-type headache with medication overuse: pathophysiology and clinical implications. Current pain and headache reports. 2009;13(6):463-469. doi:10.1007/s11916-009-0075-0
11. Podemski R, editor. Compendium of neurology. Gdańsk (PL): Via Medica; 2019. 404 p
12. Alnasser A, Alhumrran H, Alfehaid M, Alhamoud M, Albunaian N, Ferwana M. Paracetamol versus ibuprofen in treating episodic tension-type headache: a systematic review and network meta-analysis. Scientific reports. 2023;13(1):21532. doi:10.1038/s41598-023-48910-y
13. Diener HC, Gold M, Hagen M. Use of a fixed combination of acetylsalicylic acid, acetaminophen and caffeine compared with acetaminophen alone in episodic tension-type headache: meta-analysis of four randomized, double-blind, placebo-controlled, crossover studies. The journal of headache and pain. 2014;15(1):76. doi:10.1186/1129-2377-15-76
14. Siemiński M. Tension-type headaches in family doctor practice. Family Medicine Forum. 2017;11(6):255–262.
15. Banzi R, Cusi C, Randazzo C, Sterzi R, Tedesco D, Moja L. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults. The Cochrane database of systematic reviews. 2015;2015(5):CD011681. doi:10.1002/14651858.CD011681
16. Shukla R, Nag D, Ahuja RC. Alprazolam in chronic tension type headache. The Journal of the Association of Physicians of India. 1996;44(9):641-644.
17. Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology. 2004;62(10):1706-1711. doi:10.1212/01.wnl.0000127282.90920.8c
18. Turkistani A, Shah A, Jose AM, et al. Effectiveness of Manual Therapy and Acupuncture in Tension-Type Headache: A Systematic Review. Cureus. 2021;13(8):e17601. doi:10.7759/cureus.17601
19. Varangot-Reille C, Suso-Martí L, Romero-Palau M, Suárez-Pastor P, Cuenca-Martínez F. Effects of Different Therapeutic Exercise Modalities on Migraine or Tension-Type Headache: A Systematic Review and Meta-Analysis with a Replicability Analysis. The journal of pain. 2022;23(7):1099-1122. doi:10.1016/j.jpain.2021.12.003
20. Pi C, Liu Y, Li L, Tang W, Yan X, Yu S. Effects on neuromodulation, acupuncture, and aerobic exercises on migraine and tension-type headache outcomes: A systematic review and meta-analysis. Medicine. 2022;101(45):e30530. doi:10.1097/MD.0000000000030530
21. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. The Cochrane database of systematic reviews. 2009;(1):CD007587. doi:10.1002/14651858.CD007587
22. Do TP, Heldarskard GF, Kolding LT, Hvedstrup J, Schytz HW. Myofascial trigger points in migraine and tension-type headache. The journal of headache and pain. 2018;19(1):84. doi:10.1186/s10194-018-0913-8
23. Moraska AF, Stenerson L, Butryn N, Krutsch JP, Schmiege SJ, Mann JD. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. The Clinical journal of pain. 2015;31(2):159-168. doi:10.1097/AJP.0000000000000091
24. Takekawa T, Chino T, Yamada N, Watanabe S, Abo M, Sengoku R. Multimodal treatment, including extracorporeal shock wave therapy, for refractory chronic tension-type headache: a case report. Journal of medical case reports. 2023;17(1):478. doi:10.1186/s13256-023-04092-9
25. Martín-Vera D, Sánchez-Sierra A, González-de-la-Flor Á, García-Pérez-de-Sevilla G, Domínguez-Balmaseda D, Del-Blanco-Muñiz JÁ. Efficacy of a strength-based exercise program in patients with chronic tension type headache: a randomized controlled trial. Frontiers in neurology. 2023;14:1256303. doi:10.3389/fneur.2023.1256303
26. Mousavi SA, Mirbod SM, Khorvash F. Comparison between efficacy of imipramine and transcutaneous electrical nerve stimulation in the prophylaxis of chronic tension-type headache: a randomized controlled clinical trial. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences. 2011;16(7):923-927.
27. Kachhadia MP, Khalil ZM, Shah S, et al. Role of Yoga as Adjunctive Therapy for Migraines: A Narrative Review of the Literature. Cureus. 2023;15(11):e48434. doi:10.7759/cureus.48434
28. Anheyer D, Klose P, Lauche R, Saha FJ, Cramer H. Yoga for Treating Headaches: a Systematic Review and Meta-analysis. Journal of general internal medicine. 2020;35(3):846-854. doi:10.1007/s11606-019-05413-9
29. Krøll LS, Callesen HE, Carlsen LN, et al. Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education for patients with tension-type headache. A systematic review and meta-analysis. The journal of headache and pain. 2021;22(1):96. doi:10.1186/s10194-021-01298-4
30. Harris P, Loveman E, Clegg A, Easton S, Berry N. Systematic review of cognitive behavioural therapy for the management of headaches and migraines in adults. British journal of pain. 2015;9(4):213-224. doi:10.1177/2049463715578291
31. Gu Q, Hou JC, Fang XM. Mindfulness Meditation for Primary Headache Pain: A Meta-Analysis. Chinese medical journal. 2018;131(7):829-838. doi:10.4103/0366-6999.228242
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Julia Łabuda, Dawid Falkowski, Marta Frank, Magdalena Kozłowska, Gracjan Kozłowski, Urszula Rewaj-Nowicka, Jowita Szwedo

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 61
Number of citations: 0