Tension-type headaches may actually be a form of migraine headache, which means that many of the medications that work for migraines may work for these headaches as well. See migraine headache treatment. (Your treatment may vary depending upon your sensitivity to certain medications or therapy approaches or your health-care provider’s recommendations.) Following are medications commonly used for treatment of tension-type headaches:

Mild Non-narcotic Analgesics – Aspirin, acetaminophen, and the nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naprosyn.
Comments:? For mild headache, only. Daily use of aspirin and/or acetaminophen may lead to rebound headaches. Frequent use of aspirin and NSAIDs can lead to gastrointestinal bleeding and, in the case of aspirin, tinnitus (ear ringing).

 Mixed Analgesics, with and without Codeine - Includes acetaminophen/codeine and isometheptene (Midrin), a combination drug of isometheptene, acetaminophen, dichloralphenazone.
Comments: For mild to moderate tension-type headaches. Isometheptene should not be used if you have coronary artery disease, or with monoamine oxidase inhibitors. Daily use may lead to rebound headaches.

Tricyclic Antidepressants - Includes amitriptyline (Elavil), nortriptyline (Pamelor), Doxepin (Sinequan).
Comments: May cause dry mouth, blurry vision, urinary retention, constipation  or lightheadedness caused by lowering of blood pressure when suddenly arising, particularly in the elderly. Use with caution if you have heart disease.

Preventative Treatments

Calcium-Channel Blockers - Verapamil (Calan, Isoptin).
Comments: First choice treatment to prevent cluster headaches, although weeks of therapy may be required to control headaches. Agents may cause water retention, fatigue or constipation.

Corticosteroids - Prednisone, dexamethasone (Decadron).
Comments: While 80 percent to 90 percent reliable in preventing cluster headache attacks during active therapy, steroids are not appropriate for prolonged preventive therapy. Used regularly, they may cause side effects, including edema (water retention), hyperglycemia (elevated blood sugar), decreased wound healing, bone resorption and mood changes.

Daily Ergot Derivative Use - Ergotamine tartrate and Dihydroergotamine (DHE).
Comments:?

• Daily use of ergotamine tartrates (ErgostatSL, Cafergot, Wigraine) is reserved for the most extreme and debilitating cases due to a high incidence of side effects, including rebound or chronic headaches. As a result, ergotamine use typically is limited to no more than two days per week.
• DHE is similar to ergotamine, but is not associated with rebound headaches.

The Triptans – Sumatriptan (Imitrex), Naratriptan (Amerge), Rizatriptan (Maxalt) and Zolmitriptan (Zomig).
Comments: For best results, use these medications soon after the headache begins. Triptans should not be used if you have coronary artery disease, heart disease, or with ergotamine migraine medication. They may cause flushing, tingling, warmth, numbness or tightness in the chest. Do not use in aura phase of migraine with aura.? Sumatriptan comes in pill and spray form.

Anticonvulsants - Valproic Acid (Depakote).
Comments: Recently approved by the FDA for migraine prevention, it may cause weight gain, nausea, vomiting, diarrhea and dizziness.? Warning: Cases of acute and fatal liver problems have been associated with Depakote use.

Daily Opioids
Comments: Reserved for extreme cases where all other reasonable treatments have failed or cannot be used to prevent cluster headaches.

Other Preventive Treatments - A number of other therapies have been used to prevent cluster headaches.? Among them are: lithium, methysergide/methylergonovine, divalproex sodium, and transdermal or oral clonidine.

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Complementary Therapies

Acupuncture - Originating in China, this age-old practice involves inserting long, extremely slender needles into specific points along the body to relieve pain and discomfort.
Biofeedback - This involves a learning process whereby certain visual or auditory (sound-based) feedback allows you to train yourself to initiate responses that help control or normalize your psychological response to pain.
Chiropractic - According to the International Chiropractic Association, the primary focus of chiropractic is the detection, reduction and correction of spinal misalignments and nervous system dysfunction. Doctors of chiropractic attempt to get to the root cause of a health problem, rather than just treat the symptoms. Chiropractic seeks to maximize the natural strengths of the body and its capacity to heal itself without the use of drugs or surgery.
Hypnosis - This involves entering an altered state of consciousness whereby suggestions inserted while in that state can lead to changes in behavior or, in the case of pain, altered physical sensations. Self-hypnosis involves inducing an altered state of consciousness — and thus controlling pain sensation — by yourself.
Visual Imagery – The practice of using one’s imagination to create mental pictures can help relieve pain – why it works isn’t understood. Typically, this involves closing your eyes and imaging something like a healing energy washing over your body, or the “wires” to the pain being severed.

Preventive medications may require several weeks or more to build up in your nervous system before they take effect. So don’t get frustrated if you haven’t seen improvements shortly after you begin taking the drug — it may take a couple of months or longer. Also be aware that overusing caffeine or painkillers for acute relief may reduce the effect of a preventive drug.

To obtain the greatest benefit from preventive medication, keep your use of acute pain relievers to a minimum. Your doctor will monitor your treatment to see how the preventive medication is working. If your headaches are under control, your dose of medication may be reduced gradually over time.