When one begins to have tension-type headaches more than 15 days a month, then it is necessary to avoid the medications mentioned in the acute treatment web page. This is because overuse of any pain medication can lead to rebound headache where the pain medicine itself causes the headaches to continue. These headaches are the hardest headaches to treat.

The best studied medication for chronic tension-type headaches is Zanaflex® or tiazidine. Used more commonly are the older tricyclic antidepressants, particulary amitriptyline. The difficulty with this medication is it tends to cause significant weight gain. The newer antidepressants of the class SSRI (Selective Serotonin Reuptake Inhibitor) are also popular to use. They may cause some weight gain but this is less common than and to a smaller degree than the older tricyclic antidepressants. The best studies of this class is Prozac® or fluoxetine. Prozac® has the advantage of also being available in a once weekly form. At present, the weekly form has not been studied for this particular use so I will use the daily form until the headaches are under control and then switch to the weekly form.

If a patient fails the more common treatments above, then Neurontin® and Botulinum toxin is gaining use. Neurontin® is the safest of all of the oral medications used for this condition and therefore will sometimes be used first on a patient on a significant amount of simultaneous medications. Botulinum toxin has even fewer side effects but a substantially higher cost and has to be repeated every 3 months. This high cost is one reason why it is used less frequently than other options.