# Tension-type headache - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Nervous System Disorders 2025 · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) · Ibuprofen 400mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1548) · Muscle Contraction Tension Headache - StatPearls - NCBI Bookshelf (NBK562274) - the article states the dose, titration and course for this indication - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Nervous System Disorders 2025 - Ibuprofen 400mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1548) - Muscle Contraction Tension Headache - disease-level clinical article (tension-headache-full.txt) - Tension-type headache - disease-level clinical article (tension-headache-clinical.txt) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) - Amitriptyline — 25 mg — oral.solid ## Complete treatment card ```text TENSION-TYPE HEADACHE Sources: Egyptian National Drug Formulary - Nervous System Disorders 2025 · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) · Ibuprofen 400mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1548) · Muscle Contraction Tension Headache - StatPearls - NCBI Bookshelf (NBK562274) - the article states the dose, titration and course for this indication Review status: REVIEWED against Egyptian National Drug Formulary - Nervous System Disorders 2025, Ibuprofen 400mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1548), Muscle Contraction Tension Headache - disease-level clinical article (tension-headache- full.txt), Tension-type headache - disease-level clinical article (tension-headache-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Patients typically describe the pain as dull and pressing, like a tight band around the head - Episodes typically last 30 minutes to 7 days, averaging around 4 to 6 hours - Routine activity like walking or climbing stairs does not worsen the pain, and patients can continue their usual activities - Symptoms are typically milder in the morning and worsen through the evening - Patients often report tight neck or shoulder muscles along with sleep problems - Nausea, vomiting, light sensitivity, and sound sensitivity are usually absent or only mild SIGNS - what you find (3) - The physical exam is generally normal in tension-type headache [headache] - A case-control study found weaker neck extensor muscles and a lower extension-to-flexion strength ratio in TTH patients versus healthy controls - Exam should look for red flags such as neck stiffness, focal neurologic deficits, or papilledema, which point to a secondary cause instead [neck stiffness] TESTS (4) - Diagnosis is clinical, based on IHS criteria, and lab tests or imaging are not usually needed - When a red flag is present, an urgent noncontrast head CT is used to rule out bleeding or a mass - A lumbar puncture is added to exclude subarachnoid hemorrhage when the CT scan is normal - For non-urgent concerning headaches, gadolinium-enhanced brain MRI is the preferred study IF NOT THIS - what else fits (7) - Migraine differs by being more severe, often one-sided and throbbing, worsened by activity, and lasting 4 to 72 hours - Medication overuse headache is distinguished by frequent analgesic, triptan, or ergotamine use exceeding 15 days a month for over 3 months - Rebound headache classically wakes the patient and briefly improves with analgesics before returning as the drug wears off - Hypnic headache starts after age 50 and occurs only during sleep, waking the patient - COVID-19 headache is suggested by younger age, a prior headache history, and accompanying loss of smell, loss of taste, or muscle aches - Secondary headache causes needing exclusion include giant cell arteritis, sleep apnea, cardiac cephalgia, and cervicogenic headache - Red flags favoring a secondary cause include sudden onset, new onset at or after age 50, very severe pain, new headache with an underlying illness, or an accompanying systemic illness Source StatPearls "Muscle Contraction Tension Headache" - disease-level clinical article Status traced to the source above Rx: Main treatment | Preventive for chronic tension-type headache - not for the acute attack MAIN TREATMENT - choose one 1. PARACETAMOL [1st line] Adult 500-1000 mg orally every 4-6 hours (max 4 g/day) - as required Peds 15 mg/kg/dose [child max 500 mg] (15 mg/kg per dose every 4-6 hours (max 60 mg/kg/day)) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source Egyptian National Drug Formulary - Nervous System Disorders 2025 Why Simple analgesic alternative to NSAIDs for tension-type headache, preferred when NSAIDs are unsuitable, such as in pregnancy or in patients with gastrointestinal or renal risk. Caution Preferred over an NSAID where there is gastrointestinal or renal risk. On pregnancy MSF Essential Drugs 2024 is explicit: it records no contra-indication. Strictly adhere to 4 g daily limit to avoid severe liver toxicity. Check all co-formulated products for hidden paracetamol content. 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [1st line] Adult 400 mg orally at onset of headache, repeat every 6-8 hours if needed (max 1.2 g/day OTC) Peds Not suitable for children under 12 years. Choice Alternatives. NICE CG150 1.3.4 offers aspirin, paracetamol or an NSAID with no stated preference; ibuprofen has the better evidence in tension-type headache. Source Ibuprofen 400mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1548) Why NSAID taken at headache onset to relieve pain via COX-mediated prostaglandin inhibition; a standard option for tension-type headache, used with caution against overuse. Caution WARN AGAINST MEDICATION OVERUSE HEADACHE (limit simple NSAIDs/paracetamol to <15 days/month). Take with food to minimize GI discomfort. Avoid in active GI bleeding or severe asthma. The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Muscle Contraction Tension Headache - disease-level clinical article (tension-headache- full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Red flags for a secondary headache disorder, which should prompt investigation rather than a diagnosis of tension-type headache with OTC analgesic advice: sudden onset, age of onset >=50, very severe headache, new headache with an underlying medical condition, concomitant systemic illness, focal neurologic signs, papilledema, history of head trauma. PREVENTIVE FOR CHRONIC TENSION-TYPE HEADACHE - NOT FOR THE ACUTE ATTACK 4. AMITRIPTYLINE [2nd line] Adult Start at 10 mg to 25 mg once daily at night and increase by 10 mg to 25 mg each week until it works or side effects stop you - Continue for at least 6 months in responders, then try withdrawing it Peds Safety and effectiveness in children have not been established. Source Muscle Contraction Tension Headache - StatPearls - NCBI Bookshelf (NBK562274) - the article states the dose, titration and course for this indication Why Every drug on the card treats the attack, so a patient with headache on most days has nothing but more analgesia - which is how medication-overuse headache starts. This is the preventive the article calls the most effective. Caution It prevents headaches, it does not stop one - and the response takes weeks, so tell the patient that before he abandons it. Never combine it with a monoamine oxidase inhibitor. Expect dry mouth and drowsiness; avoid it in glaucoma, in urinary retention and where an arrhythmia is known. Egypt TRYPTIZOL 25 MG 30 TABS. KAHIRA 33.00 EGP (1.10/unit) GRANITYLLIN 25MG/5ML SYP. 120 ML GRAND PHARMA ... 5.00 EGP -> ? strength differs, ? different route - not oral solid ZINOTRAVAL 25MG/5ML SYP. 120 ML DEBEIKY > PHA... 10.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)