Tension-type headache

When compared with migraine headache, tension headache (TH) is less likely associated with nausea and the inability to tolerate oral analgesia. Therefore, the need to provide injectable NSAIDs is less important, but parenteral agents such as ketorolac and metamizol have been found to outperform placebo. The tension-type pain of TH is sometimes treated with benzodiazepines. Muscle relaxants such as cyclobenzaprine, chlormezanone, and tizanidine have been investigated for TH, but the existing evidence does not support their use in the ED. Although opioids may have some role for refractory TH, evidence support for their use is limited. Anecdotal reports endorse use of PO tramadol for TH. One of the few existing comparisons between an opioid and an antiemetic found meperidine less reliable for TH relief than metoclopramide, assuming the pain is real, and providing appropriate rescue analgesia is the best course for TH or any other headache syndrome.