Which of the following medications should be avoided as a first-line treatment for tension headaches in children?

Opioids should be avoided as a first-line treatment for tension headaches in children due to their potential for misuse and dependency. While the other medications listed—acetaminophen, ibuprofen, and aspirin—are generally considered safe and effective for managing tension headaches, opioids carry significant risks, particularly in pediatric populations. They can lead to adverse side effects, including respiratory depression, and they offer no particular advantage in treating tension headaches compared to the safer options.

Additionally, tension-type headaches are typically mild to moderate in intensity and often respond well to non-opioid analgesics. Therefore, using opioids as a first-line treatment is not recommended and is inconsistent with evidence-based guidelines for headache management in children.