Medications

Pain-Relievers 

• Mixed analgesics – These medicines are pain-relievers that contain more than one active ingredient. For example, Excedrin contains acetaminophen, aspirin and caffeine, and Fiorinal contains butalbital and aspirin. You may take these if mild analgesics are not strong enough to relieve your headache pain or if you headache is more severe. Some

Preventive medications
Certain medications taken at regular intervals may reduce the frequency and severity of attacks. Your doctor may prescribe these if you have frequent headaches or have tension headaches that aren't relieved by acute medication and nondrug therapy such as stress management. Your doctor also may recommend preventive medication if your headache pain becomes disabling or causes you to overuse acute medication, or if you can't take acute medication because of other medical conditions.

Doctors may prescribe antidepressants to prevent tension headache, especially the chronic form. These drugs aren't painkillers. Rather, they work to stabilize the levels of brain chemicals such as serotonin, which may be involved in the development of a headache. You don't have to have depression in order to use these drugs.

Preventive medications may include:

• Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and nortriptyline (Pamelor), are the most commonly used medications to prevent tension headache. They're effective against both the episodic and chronic forms. Side effects of these medications may include weight gain, drowsiness and dry mouth.
• Selective serotonin reuptake inhibitors (SSRIs). Antidepressants such as paroxetine (Paxil), venlafaxine (Effexor) and fluoxetine (Prozac, Sarafem) produce fewer side effects than do the tricyclic antidepressants but generally aren't considered effective for tension headaches.
• Other medications. Other medications that may prevent tension headache include anticonvulsants, such as topiramate (Topamax) and gabapentin (Neurontin), and muscle relaxants, such as tizanidine (Zanaflex).

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.

Preventive, or “prophylactic,” medicines are taken every day to prevent headaches from starting. They are used to treat chronic headaches that occur more than twice a week and/or are extremely painful. They are also prescribed when other headache medicines or remedies do not work or cannot be used. More commonly-used medicines include:

• Tricyclic anti-depressants (TCAs) – These medicines were originally used to treat depression and related disorders. However, headache experts have learned that TCAs can also help prevent and relieve chronic TTH. A TCA such as amitriptyline (Elavil) is often the first medicine of choice for preventing chronic TTH. TCAs are often begun at lower doses and are slowly increased. In addition to relieving pain, TCAs may improve sleep and decrease depression in people who have it. Other TCAs given for chronic TTH include nortriptyline (Pamelor), desipramine (Norpramin), doxepin (Sinequan) and clomipramine (Anafranil).

• Anti-convulsants – These medicines were originally used to treat seizures (convulsions or epilepsy). Now, certain anti-convulsants are also used to help prevent chronic TTH. Your health care provider may give you an anti-convulsant if TCAs failed to relieve your headaches. Examples include valproic acid (Depakote), gabapentin (Neurontin) and topiramate (Topamax).

Other Medicines

• Muscle relaxants – These medicines are also called “anti-spasmodics.” They given to relax tight muscles. They may be given alone, but medical research shows that they are more effective when given together with a medicine such as a TCA. Examples of muscle relaxants are tizanidine (Zanaflex) and metaxalone (Skelaxin). More research needs to be done on the effectiveness of muscle relaxants as a treatment for TTH.