What are the recommended first-line treatments for adults with tension-type headaches in primary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For adults with tension-type headache in primary care, the recommended first-line treatment for episodic tension-type headache is to advise the use of over-the-counter, simple analgesia such as paracetamol, aspirin, or a nonsteroidal anti-inflammatory drug (NSAID) as soon as possible after the onset of an attack .

For frequent episodic or chronic tension-type headache, it is recommended to avoid frequent and excessive use of acute analgesia due to the risk of medication overuse headache .

In addition, non-pharmacological options such as a course of 6–10 sessions of acupuncture, physiotherapy, regular exercise, cognitive behavioural therapy (CBT), and relaxation techniques may be considered as helpful adjuncts .

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