Treatment of Tension-Type Headache in Chronic TTH: Headache Occurring on 15 or More Days per Month

Chronic tension-type headache is defined by headache on ≥15 days per month on average for more than 3 months (≥180 days per year). At this frequency, prophylactic pharmacotherapy is indicated and should be considered in all patients with chronic TTH.

A specific first-choice agent is recommended for prophylaxis in chronic TTH — initiated at a carefully controlled starting dose and adjusted according to therapeutic response and tolerability. The full regimen, titration schedule, maintenance approach, and reassessment criteria are outlined in the complete structured protocol.

The primary aim is a meaningful reduction in headache frequency. A significant therapeutic response may be observed within the first week on the therapeutic dose; response is formally assessed after 4 weeks on the maintenance dose.