Treat tension headaches with first-line options like acetaminophen (500–1000 mg every 4–6 hours, max 3000 mg/day) or NSAIDs such as ibuprofen (200–400 mg every 6–8 hours) or naproxen (220 mg every 8–12 hours). Combination analgesics with caffeine, like Excedrin, may offer added relief. For chronic or severe cases, prescription muscle relaxants or preventive medications, such as tricyclic antidepressants, may be needed.
January 13, 2025

Tension Headache Solutions

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Tension headaches are the most common type of headache, characterized by a dull, aching sensation around the head, often triggered by stress or muscle tension.

First-line recommendations:

  • Acetaminophen: Provides effective pain relief. Dose: 500-1000 mg orally every 4-6 hours as needed (max: 3000 mg/day for OTC use). Tylenol Extra Strength Coated Tablets (FDA M013).

  • NSAIDs: Reduce pain and inflammation. Ibuprofen (FDA N021472) dose: 200-400 mg PO every 6-8 hours as needed. Naproxen (FDA ANDA 204872) dose: 220 mg orally every 8-12 hours as needed. Do not exceed the daily maximum dose indicated on the medication label.

Second-line recommendations:

Prescription medications:

  • Muscle relaxants: For associated muscle tension.

Preventive medications: Tricyclic antidepressants or SSRIs for chronic cases.

Citations:

Silberstein, S. D., Lipton, R. B., & Dalessio, D. J. (2019). Tension-type headache. Headache in Clinical Practice, 3rd Ed.

What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

How does MDandMe select recommended products?

  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

How does MDandMe select recommended devices?

  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

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