What treatment option is recommended for severe tension headaches?

Severe tension headaches are typically characterized by bilateral, pressing or tightening pain that can be moderate to severe in intensity. For the acute management of tension headaches, nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen are considered first-line treatments. These medications aim to relieve pain and reduce inflammation, which can alleviate the symptoms associated with acute tension-type headaches effectively.

NSAIDs, such as ibuprofen or naproxen, work by inhibiting cyclooxygenase (COX) enzymes, leading to decreased production of prostaglandins, which play a role in pain and inflammation. Acetaminophen, while not an anti-inflammatory agent, helps to reduce pain by acting on the central nervous system. Patients often find these treatments to be effective for immediate relief of headache symptoms.

Propranolol and topiramate are primarily utilized for the prevention of headaches rather than for acute treatment. Propranolol is a beta-blocker that can help reduce the frequency of tension headaches over time, and topiramate is an anticonvulsant often prescribed for the prevention of migraines and chronic headaches. Triptans, while effective for migraines, are not indicated for tension-type headaches, as they target the vascular changes associated with migraine path