General measures in the management of tension headache

The following general measures may help in the management of tension-type headaches:

• avoid:
  • overwork & stress
  • excess alcohol
  • lack of exercise - tension type headache is more commonly seen in sedentary people (1)
• clinical depression should be treated (1)
• avoid analgesic abuse:
  • a maximum of 12 analgesic doses per week should be allowed
  • withdrawal of analgesics may cause rebound symptoms for up to 14 days
• keeping a headache diary to help in the diagnosis and management (2)
• physiotherapy – specially for musculoskeletal symptoms e.g. - massage, mobilisation, manipulation and correction of posture (1)
• strategies to counteract stress - lifestyle changes, relaxation therapy and cognitive training (1)
• reassurance is often important specially in episodic tension headaches (1)
• identifying and proper management of underlying trigger factors e.g. emotional stress, anxiety, depression (1,3)
• consider a course of up to 10 sessions of acupuncture over 5-8 weeks for the prophylactic treatment of chronic tension-type headache (4)

Reference:

• (1) British Association for the Study of Headache 2007. Guidelines for All Healthcare Professionals in the Diagnosis and Management of Migraine Tension-Type, Cluster and Medication-Overuse Headache
• (2) Scottish Intercollegiate Guidelines Network (SIGN) 2008. Diagnosis and management of headache in adults
• (3) Castells ET et al. Use of amitriptyline for the treatment of chronic tension-type headache. Review of the literature. Med Oral Patol Oral Cir Bucal. 2008;13(9):E567-72
• (4) NICE (November 2015). Headaches - Diagnosis and management of headaches in young people and adults