Dawaa Reference

chronic

Tension-type headache

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Egyptian National Drug Formulary - Nervous System Disorders 2025 · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) · Ibuprofen 400mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1548) · Muscle Contraction Tension Headache - StatPearls - NCBI Bookshelf (NBK562274) - the article states the dose, titration and course for this indication

Verified against4 documents
  • Egyptian National Drug Formulary - Nervous System Disorders 2025
  • Ibuprofen 400mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1548)
  • Muscle Contraction Tension Headache - disease-level clinical article (tension-headache-full.txt)
  • Tension-type headache - disease-level clinical article (tension-headache-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Patients typically describe the pain as dull and pressing, like a tight band around the head
  • Episodes typically last 30 minutes to 7 days, averaging around 4 to 6 hours
  • Routine activity like walking or climbing stairs does not worsen the pain, and patients can continue their usual activities
  • Symptoms are typically milder in the morning and worsen through the evening
  • Patients often report tight neck or shoulder muscles along with sleep problems
  • Nausea, vomiting, light sensitivity, and sound sensitivity are usually absent or only mild

Signs — what you find (3)

  • The physical exam is generally normal in tension-type headache [headache]
  • A case-control study found weaker neck extensor muscles and a lower extension-to-flexion strength ratio in TTH patients versus healthy controls
  • Exam should look for red flags such as neck stiffness, focal neurologic deficits, or papilledema, which point to a secondary cause instead [neck stiffness]

Tests (4)

  • Diagnosis is clinical, based on IHS criteria, and lab tests or imaging are not usually needed
  • When a red flag is present, an urgent noncontrast head CT is used to rule out bleeding or a mass
  • A lumbar puncture is added to exclude subarachnoid hemorrhage when the CT scan is normal
  • For non-urgent concerning headaches, gadolinium-enhanced brain MRI is the preferred study

If not this — what else fits (7)

  • Migraine differs by being more severe, often one-sided and throbbing, worsened by activity, and lasting 4 to 72 hours
  • Medication overuse headache is distinguished by frequent analgesic, triptan, or ergotamine use exceeding 15 days a month for over 3 months
  • Rebound headache classically wakes the patient and briefly improves with analgesics before returning as the drug wears off
  • Hypnic headache starts after age 50 and occurs only during sleep, waking the patient
  • COVID-19 headache is suggested by younger age, a prior headache history, and accompanying loss of smell, loss of taste, or muscle aches
  • Secondary headache causes needing exclusion include giant cell arteritis, sleep apnea, cardiac cephalgia, and cervicogenic headache
  • Red flags favoring a secondary cause include sudden onset, new onset at or after age 50, very severe pain, new headache with an underlying illness, or an accompanying systemic illness

SourceStatPearls "Muscle Contraction Tension Headache" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Preventive for chronic tension-type headache - not for the acute attack

MAIN TREATMENT - choose one

1

PARACETAMOL

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500-1000 mg orally every 4-6 hours (max 4 g/day) - as required

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(15 mg/kg per dose every 4-6 hours (max 60 mg/kg/day))

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

Egyptian National Drug Formulary - Nervous System Disorders 2025

Why

Simple analgesic alternative to NSAIDs for tension-type headache, preferred when NSAIDs are unsuitable, such as in pregnancy or in patients with gastrointestinal or renal risk.

Cautions
  • Preferred over an NSAID where there is gastrointestinal or renal risk. On pregnancy MSF Essential Drugs 2024 is explicit: it records no contra-indication.
  • Strictly adhere to 4 g daily limit to avoid severe liver toxicity.
  • Check all co-formulated products for hidden paracetamol content.
  • 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
2

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg orally at onset of headache, repeat every 6-8 hours if needed (max 1.2 g/day OTC)

Paediatric dose

Not suitable for children under 12 years.

Choice

Alternatives. NICE CG150 1.3.4 offers aspirin, paracetamol or an NSAID with no stated preference; ibuprofen has the better evidence in tension-type headache.

Dose source

Ibuprofen 400mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1548)

Why

NSAID taken at headache onset to relieve pain via COX-mediated prostaglandin inhibition; a standard option for tension-type headache, used with caution against overuse.

Cautions
  • WARN AGAINST MEDICATION OVERUSE HEADACHE (limit simple NSAIDs/paracetamol to <15 days/month).
  • Take with food to minimize GI discomfort.
  • Avoid in active GI bleeding or severe asthma.
  • The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP
3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Muscle Contraction Tension Headache - disease-level clinical article (tension-headache-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Red flags for a secondary headache disorder, which should prompt investigation rather than a diagnosis of tension-type headache with OTC analgesic advice: sudden onset, age of onset >=50, very severe headache, new headache with an underlying medical condition, concomitant systemic illness, focal neurologic signs, papilledema, history of head trauma.

PREVENTIVE FOR CHRONIC TENSION-TYPE HEADACHE - NOT FOR THE ACUTE ATTACK

4

AMITRIPTYLINE

Preventive for chronic tension-type headache - not for the acute attack

2nd line

Strength25 mg

Formoral.solid

Adult dose and duration

Start at 10 mg to 25 mg once daily at night and increase by 10 mg to 25 mg each week until it works or side effects stop you - Continue for at least 6 months in responders, then try withdrawing it

Paediatric dose

Safety and effectiveness in children have not been established.

Dose source

Muscle Contraction Tension Headache - StatPearls - NCBI Bookshelf (NBK562274) - the article states the dose, titration and course for this indication

Why

Every drug on the card treats the attack, so a patient with headache on most days has nothing but more analgesia - which is how medication-overuse headache starts. This is the preventive the article calls the most effective.

Cautions
  • It prevents headaches, it does not stop one - and the response takes weeks, so tell the patient that before he abandons it.
  • Never combine it with a monoamine oxidase inhibitor.
  • Expect dry mouth and drowsiness; avoid it in glaucoma, in urinary retention and where an arrhythmia is known.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRYPTIZOL 25 MG 30 TABS.KAHIRA33.00 EGP (1.10/unit)
GRANITYLLIN 25MG/5ML SYP. 120 ML? strength differs? different route - not oral solidGRAND PHARMA > DELTA GRAND PHARMA5.00 EGP
ZINOTRAVAL 25MG/5ML SYP. 120 ML? strength differs? different route - not oral solidDEBEIKY > PHARMACHEMIC10.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.