Table 11 Pharmacological treatment of tension-type headache

Treatment of the individual episode (paracetamol, ASA, NSAID)

Avoid overuse of analgesics

Avoid opioids

Prophylactic treatment is considered in chronic tension-type headache when non-pharmacological treatment has insufficient effect and medication overuse has been excluded

Amitriptyline, mirtazapine and venlafaxine have a prophylactic effect

Be sure to inform the patient that antidepressants are given to increase the concentration of pain-inhibitory substances in the central nervous system and not to manage depression

Use a headache calendar to monitor treatment effect

Discontinuation of prophylactic medication should be attempted every 6–12 months to confirm that the patient still needs the medication and that it remains effective