Author: Rachel Ann Tee-Melegrito
People sometimes use the terms tension headache and migraine interchangeably to describe pain or pressure in the head. Differentiating the two is vital to get appropriate treatment and prevent future headaches.
Tension headache and migraine are two of the most common types of headaches.
About 3 in 4 of the general population of the United States experience tension headaches.
The characteristics of tension headaches are dull, steady pain, pressure, or tightness on both sides of the head. They may occur in rare, short episodes, or they may be chronic.
Migraine episodes are also common — they are the second-highest cause of disability in the world and the fourth most common cause of emergency visits in the U.S. According to a recent study migraine affects 21% of females and 10.7% of males in the U.S.
Migraine episodes involve throbbing or pulsating pain that may be worse on one side of the head. They may occur in stages, with the headache stage typically lasting from 4–72 hours. Nausea, vomiting, neck pain, dizziness, and nasal congestion often accompany this stage.
This article discusses the differences between tension headaches and migraine, including symptoms, causes, treatment, and prevention.
Doctors consider migraine and tension headaches to be primary headaches, or headaches where another condition is not the cause. Both tension headaches and migraine may appear slowly and gradually and vary in intensity.
Symptoms of tension headaches include:
- mild to moderate pain
- pain on both sides of the head
- a feeling of pressure, dull aching, or tightness around the head
- tender or sore scalp, neck, or back of the head
Symptoms of migraine include:
- moderate to severe, throbbing, or pulsating pain
- pain that worsens with physical activity
- pain on one or both sides of the head
- pain behind the eyes or temples
- nausea and vomiting
- sensitivity to smell, light, or sound
- numbness or tingling
Some people experience migraine with aura. Aura is often visual, but it can involve physical sensations or other symptoms. A person may have flashes of light, bright spots, or blind spots in their field of vision. They may also experience blurred vision or loss of vision.
Both tension headaches and migraine may also present with nasal congestion. Sensitivity to light or sound can also be present in tension headaches, but this is not as common.
Some migraine episodes can be mild and affect both sides of the head. This overlap between symptoms may cause confusion between the two types of headaches. However, they have more differences than similarities, such as:
- physical activities do not worsen tension headaches
- migraine episodes can start with a prodrome stage and/or aura before the headache stage. Prodrome symptoms may include:
- extreme tiredness and yawning
- difficulty concentrating
- food craving
- nausea and vomiting are not present in tension headaches
Doctors do not fully understand the causes, and there is no single cause that leads to these headaches.
Tightened neck, back, and scalp that result from factors such as stress may lead to tension headaches.
Genetic and environmental factors can cause migraine. Low levels of serotonin, a neurotransmitter that plays a crucial role in nerve communication, are also involved in migraine.
Migraine is also almost twice as common in females, suggesting that hormones may play a role in causing it.
A 2018 study on twins found that tension headache and migraine may have shared causes, including genetic factors and exposure to similar lifestyle and environmental factors.
The two conditions share common triggers, including:
- stress and anxiety
- lack of sleep
- alcohol use
- skipping meals
- caffeine withdrawal
- excessive smoking
Other known factors that trigger migraine include:
- hormonal changes
- weather changes
- bright, flashing lights
- loud sounds
- strong smells
- medicines and medication overuse
- certain foods or ingredients, such as aged cheese, chocolate, and monosodium glutamate (MSG)
The processes for diagnosing the two types of headaches are similar. Generally, if a person’s headache is mild to moderate, responds to home treatment, and is not accompanied by other symptoms, they may not need additional testing.
To establish a diagnosis, a doctor will take a detailed medical history to learn more about a person’s symptoms, including when and how often they occur. A doctor may also conduct a physical exam or a neurological exam.
If a doctor suspects migraine, a neurologist can order brain scans and blood tests to rule out other conditions that may be causing the symptoms. These can include a magnetic resonance imaging (MRI) or CT scan.
It is important to note that there are racial disparities within the healthcare system.
According to the American Migraine Foundation, 47% of Black people with headaches have an official diagnosis compared with 70% of white people. Latino people with headaches are 50% less likely to receive a migraine diagnosis than white people.
According to the United Kingdom’s National Health Service (NHS), a person may relieve tension headaches by:
- doing activities to relax, such as yoga
- developing healthy sleep habits
- using a low, firm pillow and heat or cold packs if neck pain accompanies the headache
- taking nonsteroidal anti-inflammatory drugs (NSAIDs)
Doctors may give tricyclic antidepressants (TCAs) to people with tension headaches to prevent recurrences.
The American Headache Society recommends preventive treatment if a person has four or more headache days a month.
Certain medications can relieve migraine symptoms and prevent future attacks. Doctors put medicines for migraine into two groups:
- Abortive medicines: A person takes these medicines as soon as they feel a migraine coming to reduce or stop the symptoms. These drugs include NSAIDs, triptans, and ergotamines.
- Preventive medicines: These drugs reduce the frequency, severity, and distress related to migraine symptoms. Examples include TCAs, beta-blockers, angiotensin receptor blockers, and calcitonin gene-related peptide (CGRP) inhibitors. A doctor may prescribe preventive medicine to people who have four or more headaches in a month, eight or more days with headaches in a
A person may also wish to try staying in a dark and quiet room, placing cold packs on the forehead, and keeping hydrated to relieve migraine symptoms.
According to the NHS, if abortive or preventive migraine medicines do not help, a doctor may recommend transcranial magnetic stimulation (TMS) or acupuncture.
A person can keep a log of their headaches to help identify their triggers. This may help them adopt lifestyle changes to prevent headaches from reoccurring.
The log may include:
- the foods a person eats
- the quality and length of their sleep
- their activities
- weather changes throughout the day
Exercise, such as yoga, and relaxation techniques may help prevent headaches and reduce their severity.
To help prevent headaches or the triggers that may lead to them, a person can try:
- drinking plenty of water
- maintaining a balanced diet
- keeping a healthy sleep schedule
A person with transformed or chronic migraine can experience a combination of these two headaches.
According to the International Headache Society (IHS), chronic migraine is when a person with no prior history of migraine has headaches for 15 or more days in a month. Also, the headache needs to have features of migraine for at least eight days a month for at least three months.
Headaches are often not a cause for concern. However, a person should contact their doctor if:
- the headache hinders or disrupts their daily life
- they need medications more than twice a week for relief
- there is a change in headache patterns or symptoms
Sometimes, having severe headaches can signify a serious medical condition such as stroke, aneurysm, or a brain tumor.
Go to the nearest emergency room or call 911 if any of these signs or symptoms are present:
- sudden, severe headache
- worsening headache following a head injury or trauma
- headache accompanied with fever, stiff neck, confusion, or vision, speech, and sensation changes
Tension headaches and migraine are two types of primary headaches that affect many people. They vary in severity, length, and duration. Generally, migraine episodes are more severe and may affect a person’s daily activities.
A person may manage tension headaches and migraines by understanding their triggers and using preventive strategies. Maintaining a healthy lifestyle can also help prevent the recurrence of these conditions.
People should speak with a doctor if they are experiencing frequent headaches that are affecting their daily life.