Simple analgesics work for occasional tension headache, and amitriptyline is the most strongly supported preventive for the chronic form. The most important medication issue is keeping acute use low, since frequent use converts it into a near-daily headache. Combination products containing caffeine or codeine carry a higher risk of driving that transition and are generally best avoided.
Simple analgesics work for occasional tension headache, and amitriptyline is the most strongly supported preventive for the chronic form. The most important medication issue is keeping acute use low, since frequent use converts it into a near-daily headache. Combination products containing caffeine or codeine carry a higher risk of driving that transition and are generally best avoided.
Simple analgesics and non-steroidal anti-inflammatories are effective for infrequent tension headache, and for most people that is all that is needed. The problem is that they work well enough to be used often, and frequent use produces medication overuse headache. The practical rule is to track days of use rather than doses. Combination analgesics containing caffeine or codeine carry a higher risk of driving that transition and are generally best avoided.
Where headache occurs on fifteen or more days a month for over three months, a daily preventive is considered. Amitriptyline, a tricyclic antidepressant used at doses intended for pain rather than for mood, has the strongest evidence. Others including mirtazapine and venlafaxine are sometimes used. Benefit is judged over months by counting headache days against a baseline, and doses are increased gradually because drowsiness and dry mouth otherwise end the trial early.
Non-drug approaches have genuine evidence in chronic tension-type headache and work alongside medication rather than instead of it: physical therapy, relaxation training and cognitive behavioural approaches. Addressing workstation setup, phone posture, sleep regularity and stress load produces real improvement. If medication overuse is present, withdrawing the overused drug has to happen before a preventive can be fairly judged, and headaches usually worsen temporarily first.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: headache; American Academy of Neurology; MedlinePlus, National Library of Medicine.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.