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Tension headache

Tension headache

Which medications help relieve tension headaches?

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Most people have tension headaches once in a while. The pain is dull with a feeling of pressure. It can be relieved with over-the-counter painkillers. But these medications may have side effects.

Tension headaches are considered to be primary headaches (like migraines and cluster headaches, too). This means that their cause is unknown. Most people who have tension headaches get them every now and then. The headaches can last anywhere between half an hour and several days. Tension headaches are often mild enough to manage without medicine. If not, over-the-counter painkillers can help. These include acetaminophen (paracetamol) and non-steroidal (NSAIDs) like ibuprofen, naproxen and acetylsalicylic acid (ASA, the drug in medicines like Aspirin).

Do ibuprofen and ASA relieve acute tension headaches?

Research has shown that ibuprofen can relieve the symptoms in some people: The headache was gone within two hours in

  • 13 out of 100 people who took a placebo (no medicine) and
  • 20 out of 100 people who took ibuprofen (400 milligrams).

So ibuprofen made the headache go away completely within two hours in an additional 7 out of 100 people.

ASA probably also helps to relieve tension headaches – but this has not been scientifically proven because there's a lack of research on ASA in the treatment of tension headaches.

The too-frequent use of NSAIDs like ibuprofen or ASA can lead to medication overuse headaches. So it’s important not to take these medications too often. They can also cause side effects like stomach ache, stomach ulcers or bleeding. High doses of NSAIDs can also increase the risk of complications in people with kidney damage or cardiovascular (heart and blood vessel) disease.

Does acetaminophen (paracetamol) relieve acute tension headaches?

Research has shown that acetaminophen can help to relieve tension headaches too: The headache went away within two hours in

  • 18 out of 100 people who took a placebo (no medicine) and
  • 23 out of 100 people who took acetaminophen (1,000 milligrams).

So acetaminophen made the pain go away completely within two hours in an additional 5 out of 100 people.

Taking acetaminophen too often can lead to medication overuse headaches (like ibuprofen and ASA can). Acetaminophen is broken down by the liver. Taking too much of it can cause acute liver damage.

Does adding caffeine help?

Some over-the-counter painkillers contain added caffeine. It is not clear whether these medications relieve tension headaches better than those without caffeine do. There aren't enough good-quality studies in this area to answer this question. Caffeine can cause other side effects, like nervousness or dizziness.

Are other medications helpful?

Prescription painkillers like metamizole are thought to be effective too, but they are usually not needed because tension headaches can generally be relieved enough with the over-the-counter medications mentioned above. Metamizole can have side effects like a skin rash or low blood pressure. In rare cases, it can lead to a life-threatening blood disorder (agranulocytosis) or a severe allergic reaction (anaphylaxis).

Derry CJ, Derry S, Moore RA. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database Syst Rev 2014; (12): CD009281.

Derry S, Wiffen PJ, Moore RA. Aspirin for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev 2017; (1): CD011888.

Derry S, Wiffen PJ, Moore RA et al. Ibuprofen for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev 2015; (7): CD011474.

Haag G, Diener HC, May A et al. Self-medication of migraine and tension-type headache: summary of the evidence-based recommendations of the Deutsche Migräne und Kopfschmerzgesellschaft (DMKG), the Deutsche Gesellschaft für Neurologie (DGN), the Österreichische Kopfschmerzgesellschaft (ÖKSG) and the Schweizerische Kopfwehgesellschaft (SKG). J Headache Pain 2011; 12(2): 201-217.

International Headache Society (IHS). Die Internationalen Klassifikation von Kopfschmerzerkrankungen, 3. Auflage – ICHD-3. 2018.

Stephens G, Derry S, Moore RA. Paracetamol (acetaminophen) for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev 2016; (6): CD011889.

Straube A. Therapie des episodischen und chronischen Kopfschmerzes vom Spannungstyp und anderer chronischer täglicher Kopfschmerzen (S1-Leitlinie, in Überarbeitung). AWMF-Registernr.: 030-077. 2022.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Which medications help relieve tension headaches?

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Created on April 5, 2023

Next planned update: 2026

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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