Pharmacotherapy of tension-type headache (TTH)

Tension-type headache (TTH) is a highly prevalent condition, yet it requires less medical attention than migraine, mostly because the pain and disability burden are milder.

Proper diagnosis is a paramount step in therapeutic adequacy. It comes from careful history, thorough physical examination and use of ancillary investigations when appropriate to rule out underlying causes of secondary headaches that could mimic TTH, as there is no biological marker for the condition.

Research in TTH is insufficient. Thus, pathophysiologic understanding and therapeutic innovations are lagging. In that context, the clinicians should not be surprised by the paucity of pharmacotherapeutic options.

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.