What is the role of over-the-counter analgesics in the management of tension-type headaches, and how should I counsel patients on their use?

Role of over-the-counter analgesics in tension-type headache management: For episodic tension-type headache, patients should be advised to take simple over-the-counter analgesics such as paracetamol, aspirin, or a nonsteroidal anti-inflammatory drug (NSAID) as soon as possible after the onset of an acute headache attack. Opioid medications are not recommended due to ineffectiveness and risk of adverse effects including dependency and medication overuse headache. Aspirin should not be offered to those under 16 years because of the risk of Reye's syndrome.

Patient counselling on use: Patients should be reassured about the diagnosis and informed about the appropriate use of these analgesics. They should be advised to avoid frequent and excessive use of acute analgesics to reduce the risk of medication overuse headache. Patients should be encouraged to identify and manage potential headache triggers such as stress, poor posture, neck pain, diet, and sleep disorders. The use of a headache diary can help monitor headache frequency, severity, and medication use. If headaches become frequent or chronic, patients should be counselled on alternative management options including physiotherapy, acupuncture, cognitive behavioural therapy, and prophylactic medication such as amitriptyline.

Overall, simple analgesics are effective for acute episodic tension-type headache but should be used judiciously to avoid medication overuse headache, with clear patient education on risks and appropriate use.

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