Tensiontype headache

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Reassurance and over-the-counter analgesics (acetylsalicylic acid or ibuprofen rather than paracetamol) (39) are sufficient for infrequent episodic tension-type headache. Most people with this condition manage themselves: episodic tension-type headache is self-limiting and, though it may be temporarily disabling, it rarely raises anxieties. If medication usage is on fewer than two days per week there is little risk of escalating consumption.

People consult doctors because of episodic tension-type headache when it is becoming frequent and, in all likelihood, is no longer responding to painkillers. Long-term remission is then the objective of management, as it is for chronic tension-type headache. Symptomatic medication is contraindicated for tension-type headache occurring on more than two days per week: where it is already being taken at high frequency a diagnosis of chronic tension-type headache rather than medication-overuse headache cannot be made with confidence. Whichever condition is present (and it can be both), frequently taken symptomatic medication must be withdrawn as the first step (see below).

Physiotherapy is the treatment of choice for musculoskeletal symptoms accompanying frequent episodic or chronic tension-type headache. In stress-related illness, lifestyle changes to reduce stress, and relaxation and/or cognitive therapy to develop stress-coping strategies, are the treatment mainstays. Prophylactic medication has a limited role. Amitriptyline is first-line in most cases, withdrawn after improvement has been maintained for 4-6 months. Long-term remission is not always achievable, especially in long-standing chronic tension-type headache. A pain management clinic may be the final option.

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