A review of the treatment of primary headaches. Part II: Tension-type headache.

This paper reviews pharmacological and other approaches currently used to treat tension-type headache (TTH), and examines aspects of the classification and pathogenesis of this common complaint. Accurate diagnosis is essential before treatment is prescribed and should involve complete history taking, thorough neurological examination and evaluation of possible associated factors. The most frequently used drugs for the acute treatment of TTH are non-steroidal anti-inflammatory drugs (NSAIDs) of which only some have been shown to be efficacious in placebo-controlled trials. Amitriptyline remains the first choice treatment for prophylaxis. Other antidepressants, muscle relaxants and benzodiazepines may be used, but few have been evaluated adequately in placebo-controlled trials. Biofeedback and relaxation training, demonstrated efficacious by controlled studies, may be used when the aim is to avoid the side effects of pharmacological treatment.