Tension Headaches
Meets IDS criteria for Tension Headache (IDS link)
No red flags. Tension-like HA.
Stay hydrated, Eat a balanced healthy diet, get adequate sleep (b/c dehydration, hunger, and sleep deprivation are common triggers).
Limit acute treatment to 9 days per month on average, and typically a maximum of two doses per treatment day to avoid medication overuse headache.
Discussed prophylaxis with TCA (for when requiring excessive acute tx meds).
Pt counseled assessed for stressors and comorbid contributors like depression.
Acute tx:
1st line: NSAIDs and ASA e.g. single dose of ibuprofen (400 mg), naproxen sodium (220 mg or 550 mg) or aspirin (650 to 1000 mg).
Alternative 1st line: APAP. Acetaminophen (1000 mg) is probably less effective than NSAIDs or Aspirin, but is preferred in pregnancy.
2nd line: Combination of Caffeine with ibuprofen, aspirin, or acetaminophen. E.g. Excedrin Tension Headaches ( Acetaminophen / Caffeine)
3rd line: Butalbital or opioid combination with NSAIDS, or ASA, or APAP.
NB: Don’t start with butalbital and opiate combinations. Reserve them for people who have failed NSAIDs, ASA, and APAP and combinations of those with caffeine.
Butalbital/ Acetaminophen/ Caffeine (Fioricet). Comes as 50 mg/300 mg/40 mg
Rx: Fioricet 1-2 caps po Q4h prn. Max: 6 caps / day; Don’t exceed 300mg/day of butalbital and 4g per day of acetaminophen.
Prophylaxis tx:
TCAs (nortriptyline), biofeedback.
Source: http://www.uptodate.com/contents/tension-type-headache-in-adults-acute-treatment