Tension Headaches: Pharmacological Management Essay

Introduction. Pathophysiology of Tension Headaches

• Tension-type headaches (TTH) are characterized by modest widespread pain.
• No incapacity, nausea, or photophobia.
• TTH originates in the occipital or frontal area and progresses across the head.
• Two types of TTH: episodic (< 15 days/month) and chronic (≥ 15 days/month).
• Episodic TTH is quite prevalent.
• Potential triggers for chronic TTH: sleep difficulties, stress/anxiety, temporomandibular joint dysfunction, neck discomfort, and eye strain. (Silberstein, 2021).

Definitions of the Two Drug Classes

• Analgesics:
  • Most mild to moderate TTH can be relieved with OTC analgesics, such as aspirin and acetaminophen (Silberstein, 2021).
  • Medications, also called painkillers, alleviate many sorts of pain, ranging from headaches to arthritis (Cleveland Clinic, n.d.).
• Tricyclic antidepressants:
  • The most generally prescribed medications for the treatment of TTH (Mayo Clinic, n.d.).
  • Have pain-relieving qualities and may lessen the frequency and duration of headaches (Healthwise Staff, 2017).

Discussion of 4 Medications (2 drugs from each assigned drug class)

• Preventive medication may include:
  • Aspirin: Acetylsalicylic acid (ASA) is a regularly used medicine for the treatment of pain and fever caused by a variety of conditions (“Aspirin,” n.d.).
  • Acetaminophen is an analgesic used alone or in conjunction with opioids to treat pain (“Acetaminophen,” n.d.).
  • Amitriptyline is a tricyclic antidepressant, known as Elavin, with analgetic properties (“Amitriptyline,” n.d.).
  • Protriptyline is a dibenzocycloheptene-derivative tricyclic antidepressant (TCA) (“Protriptyline,” n.d.).

Pharmacokinetics, Pharmacodynamics, Safety/Monitoring, & Pregnancy/Lactation of Aspirin

• Pharmacokinetics:
  • Acetylsalicylic acid is an anti-inflammatory as well as antipyretic; non-selective cyclooxygenase (COX) inhibitor.
  • Variety of dosages and forms: chewable pills, suppositories, and extended-release formulations.
• Pharmacodynamics: Affects prostaglandin synthesis by targeting cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2).
• Safety/Monitoring: Accidental poisoning is a highly prevalent cause of death in young children; it should be kept out of reach from children.
• Pregnancy/Lactation: While teratogenic effects were seen in animals at near-lethal levels, there is no evidence that this medicine is teratogenic in humans. (“Aspirin,” n.d.).

Pharmacokinetics, Pharmacodynamics, Safety/Monitoring, & Pregnancy/Lactation of Acetaminophen

• Pharmacokinetics:
  • Acetaminophen (paracetamol) is known as Tylenol.
  • Available in various forms, the most prevalent of which are oral.
• Pharmacodynamics: Antipyretic and analgesic effects.
• Safety/Monitoring: Can be used in individuals sensitive to salicylates or who have a history of allergies. Specific dosing recommendations for children.
• Pregnancy/Lactation: Pregnancy category C drug. Use with caution, only when necessary. (“Acetaminophen,” n.d.).

Pharmacokinetics, Pharmacodynamics, Safety/Monitoring, & Pregnancy/Lactation of Amitriptyline

• Pharmacokinetics:
  • Treatment of chronic tension-type headache (CTTH) in adults
  • Shown effectiveness in patients suffering from persistent non-malignant pain
• Pharmacodynamics: Possesses sedative and anticholinergic properties; following oral administration, it is rapidly absorbed.
• Safety/Monitoring: Cannot be taken when having IBS, sleep difficulties, diabetic neuropathy, agitation, fibromyalgia, or insomnia.
• Pregnancy/Lactation: Limited clinical data; not recommended. (“Amitriptyline,” n.d.).

Pharmacokinetics, Pharmacodynamics, Safety/Monitoring, & Pregnancy/Lactation of Protriptyline

• Pharmacokinetics:
  • A tricyclic ring structure with an alkyl amine substitution on the central ring is present.
  • Serotonin and norepinephrine reuptake inhibitors.
• Pharmacodynamics: Exhibits analgesic properties
• Safety/Monitoring: After about two weeks, the efficacy becomes apparent.
• Pregnancy/Lactation: Its safety during pregnancy and breastfeeding has yet to be proved. (“Protripline,” n.d.).

Contraindications of the 4 Medications Discussed Earlier

• Aspirin: Stomach ulcers and GI bleeding, hypertension, liver cirrhosis, kidney dysfunction, asthma (Get Relief Responsibly, n.d.).
• Acetaminophen: Hypersensitivity to the drug, severe hepatic impairment, or active hepatic disease (Gerriets et al., 2021).
• Amitriptyline: Hypersensitivity reactions, arrhythmias, infarction, angle-closure glaucoma, urinary detention (Thour & Marwaha, 2022).
• Protriptyline: Heart problems, metabolic syndrome, psychosis, pregnancy, breastfeeding, urinary retention (Saef et al., 2022).

Conclusion

• Tension-type headaches (TTH) are characterized by moderate to severe broad pain that begins in the occipital or frontal area and spreads throughout the head.
• Two drug classes are used: Analgesics and tricyclic antidepressants.
• Most of mild to moderate TTH can be alleviated with analgesics (painkillers).
• Tricyclic antidepressants can help with chronic TTH.
• Aspirin and acetaminophen are analgesics.
• Amitriptyline and protriptyline are tricyclic antidepressants.

References

Acetaminophen. (n.d.).

Amitriptyline. (n.d.).

Aspirin. (n.d.).

Cleveland Clinic. (n.d.). Analgesics.

Gerriets, V., Anderson, J., & Nappe, T. M. (2021).Acetaminophen.

Get Relief Responsibly. (n.d.). Aspirin contraindications & interactions.

Healthwise Staff. (2017). Antidepressants for tension headaches. Web.

Mayo Clinic. (n.d.). Tension headache.

Protriptyline. (n.d.).

Saef, M. A., Yilanli, M., & Saadabadi, A. (2022). Protriptyline.

Silberstein, S.D. (2021). Tension-type headache.

Thour, A., & Marwaha, R. (2022). Amitriptyline.