Headaches: Should I take prescription medicine for tension headaches?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Take a daily prescription medicine to manage your tension headaches.
Don't take a prescription medicine. Instead, treat your tension headaches only when you have them.

Key points to remember

If your tension headaches are mild to moderate, first try an over-the-counter pain medicine, such as aspirin, ibuprofen, naproxen, or acetaminophen.
If you have tension headaches for 15 days or more a month for 6 months, you may need a prescription medicine.
Even with treatment, you may still get some tension headaches. But when you do get them, they may not be as bad or last as long.
There are other things you can try besides daily medicine. For example, you could use cognitive-behavioral therapy or biofeedback.
The medicine you take may cause side effects. Some of these side effects may last for a few weeks or for as long as you take the medicine.

FAQs

What is a tension headache?

There are different kinds of headaches. Most people get tension headaches. When you have a tension headache, you may feel a constant ache, tightness, and pressure around your forehead, temples, or the back of your head and neck. It may feel like your head is in a vise.

Tension headaches usually cause mild to moderate pain. Most of the time, they aren't bad enough to stop you from doing your daily tasks. But some people have very bad headaches that last a long time. These headaches can disrupt your life.

Tension headaches tend to come back, especially when you're under stress. They can last from 30 minutes to several days.

If you have tension headaches for 15 days or more a month for 6 months, you may have chronic tension headaches. Some people who have chronic headaches also have anxiety and depression.

The cause of tension headaches is not clear. Doctors used to think that these headaches were caused by tension or spasms in the muscles of the neck, face, jaw, or head. Now they think that a change in brain chemicals may also cause these headaches.

How are tension headaches treated?

First try over-the-counter pain medicines to manage your headaches. These medicines are safe and cost less than prescription medicines. They include:

Aspirin.
Ibuprofen (such as Advil or Motrin).
Naproxen (such as Aleve).
Acetaminophen (such as Tylenol).

If these medicines don't help, your doctor may prescribe a medicine that you take each day. The doctor may examine you and ask about your symptoms to find out what kind of medicine is right for you.

Your doctor may also suggest ways to reduce stress and anxiety as a way to manage your headaches.

What prescription medicines can you take for tension headaches?

Three types of medicines are used:

Antidepressants. These include amitriptyline and mirtazapine (Remeron).
Anticonvulsants. These seizure medicines include divalproex (such as Depakote).
Antianxiety medicines. One type is buspirone (such as BuSpar).

The antidepressant amitriptyline is used most often. In some cases doctors prescribe barbiturates or narcotics when other medicines haven't worked. But you can get addicted to these medicines.

Often the best way to treat chronic tension headaches is to use medicine along with treatments that reduce stress and anxiety, such as cognitive-behavioral therapy.

How well do these medicines work?

Even with treatment, you may still get some tension headaches. But studies have shown that:

When you take them each day, the antidepressants amitriptyline and mirtazapine can greatly reduce how often you get tension headaches and how long they last.¹
The anticonvulsant divalproex can reduce how often you get tension headaches and how long they last.² It also has been shown to be safe to use for a long period of time.
The antianxiety medicine buspirone can reduce anxiety and how often you get tension headaches.

What can you expect if you take prescription medicine for tension headaches?

You'll need to take pills every day—even when you don't have a headache.

If you don't feel better after a few weeks of taking the medicine, talk to your doctor. You may need to try several different medicines to find one that works for you.

The medicine can cause side effects. Some of these side effects may last for a few weeks or for as long as you take the medicine. You may need to decide which bothers you more—the side effects of the medicine or your headaches.

Common side effects include:

Dry mouth.
Constipation.
Blurred vision.
Inability to urinate.
Weight gain.
Low blood pressure when you stand up quickly.

What else can you do to manage your tension headaches?

Some people find other ways to manage headaches besides taking medicine. These include:

Acupuncture. Tiny needles are put into certain points on your skin to relieve pain. Some research shows that this can help ease headaches.³ But more research is needed.
Biofeedback. With this treatment, you can learn to control a body function that is not normally under your conscious control, such as breathing or muscle tension.
Cognitive-behavioral therapy or problem-solving therapy. This kind of counseling can help you reduce stress and anxiety. Using counseling and antidepressants often works better than if you only take medicine.⁴
Relaxation exercises. These help you learn how to relax each muscle group. Using these exercises along with antidepressants often works better than if you only take medicine.⁴
Electrical nerve stimulation. A mild electrical current is used on specific parts of your body to help treat pain.

Here are some things you can do at home:

Figure out what may cause your tension headaches. Is it stress, anxiety, fatigue, hunger, anger, poor posture, or eye or muscle strain? Are you doing too much? It may help to keep a headache diary to track how often you have tension headaches, how painful they are, and what you think might be causing them.
Get plenty of exercise, eat healthy foods, and get enough sleep.
Use good posture to avoid muscle tension.

Why might your doctor recommend prescription medicine for your tension headaches?

Your doctor may advise you to take prescription medicine if:

You have tension headaches for 15 days or more a month.
Your tension headache lasts 7 days or more.
You have tried over-the-counter medicines, but they don't help.

2. Compare Options

	Take prescription medicine for tension headaches	Don't take prescription medicine for your headaches
What is usually involved?	You take a pill every day, even if you don't have a headache. You may also use other treatments that help to reduce stress and anxiety.	You may try over-the-counter medicines to manage your headaches. You try to avoid things that may trigger your tension headaches, such as stress, anxiety, and muscle strain.
What are the benefits?	Benefits include: Fewer or no tension headaches. Shorter headaches. Headaches that aren't as severe.	If your symptoms don't improve with other medicines, counseling, or home treatment, you can decide later to try prescription medicine. You avoid the side effects of the medicine. You avoid the cost of buying prescription medicine.
What are the risks and side effects?	Possible side effects include: Dry mouth. Constipation. Blurred vision. Inability to urinate. Weight gain. Low blood pressure when you stand up quickly. If you take a barbiturate or narcotic, you may become addicted to the medicine.	You continue to get tension headaches. If your symptoms are severe, you may miss several days of work or school.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Tension Headaches.

Personal stories about taking medicines for tension headaches

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

" My job requires me to spend a lot of time in front of a computer screen, and my eyes are sore at the end of most days. I also have a lot of stress in my life right now. I am getting frequent tension headaches, but an aspirin usually relieves the pain. I'm keeping a headache diary to see how often I get these headaches. I am going to try putting a filter on my computer screen and taking frequent breaks. I've also signed up for a yoga class to help me relax. If I continue to have tension headaches, I will take my headache diary to my doctor and see if I need stronger medicines. "

— Joyce, age 34

" Recently I've been getting tension headaches almost daily. I am taking naproxen and sometimes aspirin every day. My headaches go away for awhile but then come back within a couple of hours after taking these pain relievers. I have been feeling a little depressed and am anxious about my job and family life. My doctor said I might be getting rebound headaches from taking too many pain relievers and that I also could be depressed. She thinks I should try taking an antidepressant for awhile and has recommended that I talk to a counselor to work through a few issues I'm facing. I think I will take her advice and see if I can get these headaches under control. "

— John, age 45

"I have had a lot of changes in my life recently. I started getting headaches around the time we moved to a new town. My mom thinks they are related to stress and will go away when I feel comfortable at my new home and school. Sometimes I need to take an ibuprofen for the headache, but not always. I am learning how to do relaxation exercises at a class I'm taking, and this seems to help. My parents talked about it and decided to wait for a month to see if the headaches go away before taking me to the doctor. "

— Leslie, age 14

"I have been getting tension headaches for more than 7 months. I decided to start keeping a diary of how often I get them to try to identify any triggers. So far, it looks like I get headaches around 20 days out of every month, but I'm not sure why. While I don't miss a lot of time away from work, I do think my productivity is suffering. I've tried biofeedback to see if I could reduce stress, but that hasn't helped. My doctor thinks it is time for me to try an antidepressant to prevent tension headaches from occurring. I think I'll give that a try. "

— Jennifer, age 35

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take prescription medicine for tension headaches

Reasons not to take prescription medicine for tension headaches

I'm willing to take medicine every day, because I think it will help ease my tension headaches.

I want to take medicine only when I have a headache, at least for a while.

More important

Equally important

More important

I don't think the side effects of the medicine could be as bad as my tension headaches.

I think the side effects of the medicine would bother me more than my headaches.

More important

Equally important

More important

My tension headaches are affecting my work and relationships with friends and family.

My tension headaches aren't really affecting my work and relationships with friends and family.

More important

Equally important

More important

I'm not worried about the cost of taking a prescription medicine every day.

I'm worried about the cost of taking a prescription medicine every day.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking prescription medicine for tension headaches

NOT taking prescription medicine for tension headaches

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. If I only get tension headaches every now and then, and if they don't bother me too much, I should take prescription medicine every day to treat them.

True
False
I'm not sure

That's right. Doctors recommend that you first try an over-the-counter pain medicine, such as aspirin, ibuprofen, naproxen, or acetaminophen, before you try a prescription medicine.

2. I may still get tension headaches, even though I'm taking medicine to prevent them.

True
False
I'm not sure

That's right. You may still get some tension headaches. But when you do get them, they may not be as bad or last as long.

3. If I don't want to take medicine to treat my tension headaches, I can try other kinds of treatment that may help me feel better.

True
False
I'm not sure

That's right. There are other things you can try that don't involve taking medicine every day, such as using cognitive-behavioral therapy and biofeedback.

Decide what's next.

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a decision?

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Silver N (2006). Headache (chronic tension-type), search date October 2005. Online version of Clinical Evidence (15).
Freitag FG, et al. (2001). Divalproex in the long-term treatment of chronic daily headaches. Headache, 41: 271–278.
Melchart D, et al. (2006). Acupuncture for idiopathic headache. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.
Holroyd KA, et al. (2001). Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination. JAMA, 285(17): 2208–2215.