Tension Headaches: Pharmacological Management

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Introduction. Pathophysiology of Tension Headaches

Tension-type headaches (TTH) are characterized by modest widespread pain.
No incapacity, nausea, or photophobia.
TTH originates in the occipital or frontal area and progresses across the head.
Two types of TTH: episodic (< 15 days/month) and chronic (≥ 15 days/month).
Episodic TTH is quite prevalent.
Potential triggers for chronic TTH: sleep difficulties, stress/anxiety, temporomandibular joint dysfunction, neck discomfort, and eye strain. (Silberstein, 2021).

Analgesics:
- Most mild to moderate TTH can be relieved with OTC analgesics, such as aspirin and acetaminophen (Silberstein, 2021).
- Medications, also called painkillers, alleviate many sorts of pain, ranging from headaches to arthritis (Cleveland Clinic, n.d.).
Tricyclic antidepressants:
- The most generally prescribed medications for the treatment of TTH (Mayo Clinic, n.d.).
- Have pain-relieving qualities and may lessen the frequency and duration of headaches (Healthwise Staff, 2017).

Preventive medication may include:
- Aspirin: Acetylsalicylic acid (ASA) is a regularly used medicine for the treatment of pain and fever caused by a variety of conditions (“Aspirin,” n.d.).
- Acetaminophen is an analgesic used alone or in conjunction with opioids to treat pain (“Acetaminophen,” n.d.).
- Amitriptyline is a tricyclic antidepressant, known as Elavin, with analgetic properties (“Amitriptyline,” n.d.).
- Protriptyline is a dibenzocycloheptene-derivative tricyclic antidepressant (TCA) (“Protriptyline,” n.d.).

Pharmacokinetics:
- Acetylsalicylic acid is an anti-inflammatory as well as antipyretic; non-selective cyclooxygenase (COX) inhibitor.
- Variety of dosages and forms: chewable pills, suppositories, and extended-release formulations.
Pharmacodynamics: Affects prostaglandin synthesis by targeting cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2).
Safety/Monitoring: Accidental poisoning is a highly prevalent cause of death in young children; it should be kept out of reach from children.
Pregnancy/Lactation: While teratogenic effects were seen in animals at near-lethal levels, there is no evidence that this medicine is teratogenic in humans. (“Aspirin,” n.d.).

Pharmacokinetics:
- Acetaminophen (paracetamol) is known as Tylenol.
- Available in various forms, the most prevalent of which are oral.
Pharmacodynamics: Antipyretic and analgesic effects.
Safety/Monitoring: Can be used in individuals sensitive to salicylates or who have a history of allergies. Specific dosing recommendations for children.
Pregnancy/Lactation: Pregnancy category C drug. Use with caution, only when necessary. (“Acetaminophen,” n.d.).

Pharmacokinetics:
- Treatment of chronic tension-type headache (CTTH) in adults
- Shown effectiveness in patients suffering from persistent non-malignant pain
Pharmacodynamics: Possesses sedative and anticholinergic properties; following oral administration, it is rapidly absorbed.
Safety/Monitoring: Cannot be taken when having IBS, sleep difficulties, diabetic neuropathy, agitation, fibromyalgia, or insomnia.
Pregnancy/Lactation: Limited clinical data; not recommended. (“Amitriptyline,” n.d.).

Pharmacokinetics:
- A tricyclic ring structure with an alkyl amine substitution on the central ring is present.
- Serotonin and norepinephrine reuptake inhibitors.
Pharmacodynamics: Exhibits analgesic properties
Safety/Monitoring: After about two weeks, the efficacy becomes apparent.
Pregnancy/Lactation: Its safety during pregnancy and breastfeeding has yet to be proved. (“Protripline,” n.d.).

Aspirin: Stomach ulcers and GI bleeding, hypertension, liver cirrhosis, kidney dysfunction, asthma (Get Relief Responsibly, n.d.).
Acetaminophen: Hypersensitivity to the drug, severe hepatic impairment, or active hepatic disease (Gerriets et al., 2021).
Amitriptyline: Hypersensitivity reactions, arrhythmias, infarction, angle-closure glaucoma, urinary detention (Thour & Marwaha, 2022).
Protriptyline: Heart problems, metabolic syndrome, psychosis, pregnancy, breastfeeding, urinary retention (Saef et al., 2022).

Tension-type headaches (TTH) are characterized by moderate to severe broad pain that begins in the occipital or frontal area and spreads throughout the head.
Two drug classes are used: Analgesics and tricyclic antidepressants.
Most of mild to moderate TTH can be alleviated with analgesics (painkillers).
Tricyclic antidepressants can help with chronic TTH.
Aspirin and acetaminophen are analgesics.
Amitriptyline and protriptyline are tricyclic antidepressants.