Other Headache Types

Tension Type

Acute

Life-style advice and simple analgesia (aspirin and paracetamol).
Caution patient at risk of medication overuse: restrict analgesic use to <10 days per month and stop opioid medications (particularly if co-existent migraine)

Chronic

Treat any associated medication overuse headache (see medication overuse treatment)
Tricyclic antidepressants (e.g. Amitriptyline) two hours before bed, titrating dose depending on effect and tolerability
Clinical psychology and stress counselling
Encourage exercise, relaxation, yoga and/or massage.

Is a chronic headache i.e. it is present for 15 days or more per month for the past 3 months and it has developed / worsened while taking regular analgesia / triptans for >10 days per month for >3 months.
It can develop with any type of primary headache but is most commonly associated with migraine.

Management

Simple analgesics or triptans can be stopped abruptly
Opioids may require a gradual reduction to avoid withdrawal
There is little evidence for interventions but short term regular naproxen and anti-emetics may be considered
Prophylactic medication may not be required once MOH addressed, however in the short term prophylaxis such as Amitriptyline may be considered
Patients must be warned their headache is likely to get worse for a few weeks before it gets better