Condition

Tension Headache

Most common type of headache causing dull, aching pain

2B
People Affected
5
Active Trials
1B
New Cases/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Aspirin + Acetaminophen + Caffeine (Combination)
72% Effectiveness• 88% Confidence• 72% Safety• 150 trials• 18K participants
HIGH EvidenceExcellent ValueDose: 2 tablets (250mg Aspirin, 250mg Acetaminophen, 65mg Caffeine) every 4-6 hours, max 8 tablets/day
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
72
DangerousModerateSafe

Time to Effect

15-45 minutes

Duration

As needed for acute episodes (avoid overuse >2-3 days/week)

Response Rate

75%

Remission Rate

%

Number Needed to Treat (NNT)

5

Common Side Effects:

Nausea: 8%
Dyspepsia: 7%
Nervousness/Insomnia: 10%
Rebound Headache (with overuse): 15%

Annual Cost of Care

Drug Cost

$50

Monitoring

$1,000

Side Effects

$20

Total Annual

$1,070

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

Cost per Responder

$93.33

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+72%
Response Rate
+75%
Common Side Effects
Nausea
+8%
Dyspepsia
+7%
Nervousness/Insomnia
+10%

Clinical Trial Phases:

Phase 4
2
Ibuprofen
68% Effectiveness• 89% Confidence• 75% Safety• 5 trials• 75K participants
HIGH EvidenceExcellent ValueDose: 200-400 mg every 4-6 hours, max 1200 mg/day (OTC)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
75
DangerousModerateSafe

Time to Effect

30-60 minutes

Duration

As needed for acute episodes

Response Rate

65%

Remission Rate

%

Number Needed to Treat (NNT)

7

Common Side Effects:

Dyspepsia: 15%
Nausea: 6%
Abdominal pain: 6%

Annual Cost of Care

Drug Cost

$30

Monitoring

$1,000

Side Effects

$10

Total Annual

$1,040

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

Cost per Responder

$61.54

Treatment Outcomes
Primary Outcomes
Headache Pain Intensity6.5 on 0-10 Numeric Rating Scale
-53.8% (-3.5 points)
Headache Impact Test (HIT-6) Score58 points (severe impact, scale 36-78)
-22.4% (-13 points)
Median Time to Onset of Significant Pain Relief120 minutes (for meaningful relief without treatment)
-62.5% (-75 minutes)
Percentage of Patients Pain-Free at 2 Hours Post-Dose10% (placebo group)
+250% (+25 percentage points)
Secondary Benefits
Ability to Perform Daily Activities4 points (significantly limited, 0=unable, 10=normal)
+75% (+3 points)
Percentage of Patients Requiring Rescue Medication40% (within 24 hours post-dose, placebo)
-50% (-20 percentage points)
Patient Satisfaction Score3 points (with previous/no treatment, 0=not satisfied, 10=very satisfied)
+133.3% (+4 points)
Common Side Effects
Dyspepsia
+15%
Nausea
+6%
Abdominal pain
+6%

Clinical Trial Phases:

Phase 4
3
Naproxen
65% Effectiveness• 87% Confidence• 75% Safety• 1 trials• 60K participants
HIGH EvidenceExcellent ValueDose: 220-550 mg every 8-12 hours, max 1250 mg/day (Rx), 660mg/day (OTC)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
75
DangerousModerateSafe

Time to Effect

30-60 minutes

Duration

As needed for acute episodes

Response Rate

60%

Remission Rate

%

Number Needed to Treat (NNT)

8

Common Side Effects:

Dyspepsia: 15%
Nausea: 6%
Abdominal pain: 6%

Annual Cost of Care

Drug Cost

$35

Monitoring

$1,000

Side Effects

$10

Total Annual

$1,045

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

Cost per Responder

$75

Treatment Outcomes
Primary Outcomes
Headache Pain Intensity6.5 on 0-10 Numerical Rating Scale
-38.5% (-2.5 points)
Headache-Related Functional Impairment (HIT-6)56 on HIT-6 scale (range 36-78)
-8.9% (-5 points)
Need for Rescue Medication30% of patients
-50% (-15 percentage points)
Secondary Benefits
Associated Symptom Severity (Neck Pain)5.0 on 0-10 Numerical Rating Scale
-30% (-1.5 points)
Sleep Interference due to Headache4.0 on 0-10 Numerical Rating Scale
-30% (-1.2 points)
Productivity Loss due to Headache5.5 on 0-10 Numerical Rating Scale
-32.7% (-1.8 points)
Common Side Effects
Dyspepsia
+15%
Nausea
+6%
Abdominal pain
+6%

Clinical Trial Phases:

Phase 4
4
Acetaminophen
60% Effectiveness• 83% Confidence• 80% Safety• 2 trials• 65K participants
HIGH EvidenceExcellent ValueDose: 500-1000 mg every 4-6 hours, max 4000 mg/day
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
80
DangerousModerateSafe

Time to Effect

30-60 minutes

Duration

As needed for acute episodes

Response Rate

55%

Remission Rate

%

Number Needed to Treat (NNT)

10

Annual Cost of Care

Drug Cost

$25

Monitoring

$1,000

Side Effects

$0

Total Annual

$1,025

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.02

Cost per Responder

$45.45

Treatment Outcomes
Primary Outcomes
Headache Pain Intensity (NRS 0-10)6/10 (moderate pain)
-33.3% (-2 points)
Pain Interference with Daily Activities (NRS 0-10)7/10 (significant interference)
-28.6% (-2 points)
Overall Headache Severity (VAS 0-100 mm)70 mm (severe)
-35.7% (-25 mm)
Secondary Benefits
Health-Related Quality of Life (EQ-5D VAS 0-100)60/100
+16.7% (+10 points)
Sleep Quality (PSQI 0-21)10/21 (poor sleep)
-20% (-2 points)
Ability to Perform Work/Study Activities (NRS 0-10)4/10 (moderately impaired)
+50% (+2 points)

Clinical Trial Phases:

Phase 4
5
Amitriptyline
70% Effectiveness• 88% Confidence• 60% Safety• 3 trials• 9K participants
HIGH EvidenceGood ValueDose: 10-75 mg at bedtime (titrated)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

6-12 months, then reassess

Response Rate

60%

Remission Rate

25%

Number Needed to Treat (NNT)

4

Common Side Effects:

Drowsiness/Sedation: 40%
Dry mouth: 30%
Constipation: 18%
Weight gain: 15%
Dizziness: 10%

Annual Cost of Care

Drug Cost

$40

Monitoring

$300

Side Effects

$75

Total Annual

$415

Cost-Effectiveness

GOOD

QALYs Gained

0.2

Cost per Remission

$1,660

Cost per Responder

$691.67

Treatment Outcomes
Primary Outcomes
Headache Days per Month18 headache days/month
-40% (-7 headache days/month)
Headache Intensity (NRS 0-10)6.5/10 (NRS)
-23% (-1.5 points (NRS))
Analgesic Medication Use12 doses/week
-35% (-4 doses/week)
Secondary Benefits
Headache Impact Test (HIT-6) Score60/78 (HIT-6 score)
-13% (-8 points (HIT-6))
Pittsburgh Sleep Quality Index (PSQI) Score10/21 (PSQI score)
-30% (-3 points (PSQI))
Patient Health Questionnaire (PHQ-9) Score15/27 (PHQ-9 score)
-25% (-4 points (PHQ-9))
Common Side Effects
Drowsiness/Sedation
+40%
Dry mouth
+30%
Constipation
+18%

Clinical Trial Phases:

Phase 4