Chronic Daily Headache

Chronic Tension-Type Headaches

Chronic tension-type headaches may be managed with nonpharmacologic strategies, such as relaxation training and stress management. Stress management techniques educate patients to recognize and manage early headache signs and to recognize and reduce stress in their daily life; in doing so, patients may possibly prevent headaches, and if one does occur, certain cognitive-behavioral techniques can help to manage the pain. Although no drugs currently have FDA-approved labeling specifically for chronic tension-type headache, given the chronic nature of this disorder, prophylactic therapy (i.e., TCAs) is usually warranted for most patients. Acute headache attacks may be managed with simple or combination analgesics, but these should be limited to 2 to 3 days of medication per week to avoid medication-overuse headache.

When tension headaches are frequent, a trial of a TCA or an SSRI/SNRI may be warranted. In one study of patients with chronic tension-type headache, a combination of amitriptyline hydrochloride and stress management proved more effective than either therapy alone.⁹⁰ The SSRIs fluoxetine, paroxetine, and citalopram have not shown efficacy in controlled studies;^91-93 however, they are often used because of their lower incidence of side effects.