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#TTH2022 The management of TTH includes both pharmaceutical and non-pharmaceutical interventions and aimed at relieving pain, restoring function, and improving health related quality of life. Comorbidities should also be considered in the decision making which may include depression, anxiety, sleep disorders, neck pain, other chronic pain conditions. Infrequent TTH can be managed primarily with acute treatment and lifestyle modifications, but frequent ETTH or CTTH may require preventive pharmacotherapy and/or behavioural interventions. Patient education plays a large role in the management of TTH. he patient and to explain the pathophysiology, important lifestyle habits and factors, potential treatments, and the prognosis of the condition. Most attacks of TTH can often be managed with simple analgesics such as Paracetamol (acetaminophen), aspirin and non-steroidal anti-inflammatory drugs or NSAIDs, and nonpharmacologic strategies such as sleep hygiene, regular practice of relaxation techniques such as meditation and diaphragmatic breathing, hydration, and physical modalities such as massage. The efficacy and safety of paracetamol, aspirin, ibuprofen and ketoprofen in the acute treatment of TTH have been shown in randomized controlled studies. Other NSAIDs, such as naproxen, diclofenac, have less evidence for efficacy, yet are in common in practice. There is also evidence that caffeine when combined with acetaminophen, acetylsalicylic acid, or ibuprofen, improves the efficacy of the analgesics in the acute treatment of TTH. The key objectives of prophylactic treatment are to reduce the frequency and severity of attacks. Though preventive treatments have not been demonstrated to prevent TTH chronification, many clinicians prescribe preventives to prevent progression and to reduce the risks of complications attributable to medication overuse. For the most cases of infrequent ETTH with less than 10 days with headache per month, there is no need for prophylactic treatment. . In the case of frequent ETTH characterized by 10-14 days with headache per month, the prevention may be needed, particularly when the TTH attacks affect the ability of a person to function properly in roles such as work, school and family responsibilities. In the case of CTTH preventive treatment is indicated. Preventive therapies may be pharmacologic or non-pharmacologic. Multimodal treatment should be tailed for each individual patient and may include interventional medicine treatments. The evidence-based guidelines for the pharmacological prophylaxis of TTH recommend three agents for the preventive treatment of TTH: amitriptyline with A labeling as first line, and venlafaxine and mirtazapine with B labeling, as second line. As third line treatments the recommendation with label B includes clomipramine, maprotiline and mianserin. Tizanidine, a muscle relaxant, might be useful in practice for the prevention of CTTH. There are a range of non-pharmacologic therapies with good evidence and safety for prophylactic management of TTH. Guidelines recommend that they are considered first. They can be combined with pharmacotherapy or administered on their own, and include physical and occupational therapies, biobehavioral therapies such as cognitive behavioral therapy (CBT), biofeedback, and relaxation therapy, complimentary and integrative medicine, which include acupuncture, massage, management of sleep, dietary approaches stress management and lifestyle modifications. FOLLOW US • Website: www.ihs-headache.org • Twitter: ihs_official • Facebook: IHSheadache • Instagram: ihsheadache • LinkedIn: international-headache-society • YouTube: IHSInternationalHeadacheSociety JOIN US • Subscription to Cephalalgia • Online access to The Neuroscientist • Access to the IHS website Learning Centre • Early access to International Guidelines • Grants and fellowships • Network through the IHS Members Directory • Reduced registration to biennial International Headache Congress

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