Tension headaches cause mild to moderate pain, often described as a tight band or vise around the head that lasts between 30 minutes and 1 week, according to the National Headache Foundation. Episodic tension headaches occur randomly and are usually treated with over-the-counter pain relievers. Chronic tension headaches, on the other hand, occur at least 15 times per month and often require prescription medications to prevent or relieve attacks, according to the National Headache Foundation. The National Institutes of Health recommends combining medication therapy with biofeedback, acupuncture, stress management or cognitive behavioral therapy for the most effective relief of tension headaches.
Over-the-Counter Pain Medications
The National Headache Foundation recommends several over-the-counter pain medications--aspirin, acetaminophen, ibuprofen or naproxen sodium--as the drugs of choice for episodic tension headaches. Combination products of these medications plus caffeine are the most effective, notes NHF, because caffeine boosts the pain relief qualities of the drugs. Patients should not take aspirin or acetaminophen more than 9 days a month, cautions the Mayo Clinic, because these drugs can cause headaches if overused.
Prescription Non-Steroidal Anti-inflammatory Drugs
Health care providers avoid prescribing narcotics or sedatives for tension headache relief because they can be habit-forming. The Mayo Clinic instead recommends prescription non-steroidal anti-inflammatory drugs for severe pain relief. NSAIDs such as naproxen, indomethacin or ketorolac can be as effective as a narcotic but are not habit-forming. However, according to the National Headache Foundation, prescription NSAIDs should only be used for 5 days or less because long-term use can cause gastrointestinal bleeding, stomach ulcers or kidney damage.
Tricyclic Antidepressants
The best pain relievers for chronic tension headaches are tricyclic antidepressants--amitriptyline, protriptyline, nortriptyline, imipramine, desipramine and doxepin--that help to balance chemicals in the brain, reports the National Headache Foundation. Stress and depression have been linked to chronic tension headaches, but even patients who are not depressed can benefit from these medications. Two of these medications-- amitriptyline and nortriptyline--are the most frequently prescribed for tension headache prevention as well, notes the Mayo Clinic. Tricyclic antidepressants must be taken for several weeks before they begin to be effective, and they can cause unpleasant side effects such as weight gain, dry mouth, drowsiness, tingling, blurred vision and changes in the heart rhythm. Other antidepressants, including paroxetine, venlafaxine and fluoxetine, have fewer side effects but are not effective in treating tension headaches, according to the Mayo Clinic.
