Tension Headache vs. Migraine: How to Tell the Difference

Whether you've had headaches for years or have had a recent onset, the first step to getting the best treatment is to understand what type of headache you have.

A tension-type headache is the most common -- 90% of all headaches fall into this category. Up to 78% of Americans will suffer from them at some point. You may have them every once in a while, and they may disappear within a few hours. Or they may happen more often and last all day.

Migraine headaches aren't as common. About 14% of the population get them. But they can be much more debilitating. They typically last between 4 and 72 hours.

The length, intensity, pain location, and symptoms can be very different.

Symptoms of Tension-type Headaches

You may have a tension-type headache if:

  • You have pain on both sides of your head.
  • You have tight pressure rather than throbbing. It might feel like your head is in a vice or that there's pressure all the way around it. You may also feel soreness in your temples, and your neck and shoulder muscles may feel tight.
  • Your pain isn't severe.

Symptoms of Migraine

Migraine is a condition that results in headaches. You're more likely to have a migraine headache if:

  • You have moderate to severe throbbing pain that may be worse on one side of your head.
  • The pain gets worse the more physically active you are. Lying down may help.
  • You have pain around your eyes or temples or in your face, jaw, or neck.
  • You have sensitivity to light, sounds, and smells.
  • You're nauseous.
  • You see things like wavy lines, dots, or flashing lights. About 1 in 5 people with a migraine have this.
  • Your arm or face tingles just before your headache starts.

Causes

Tension-type headaches are usually brought on by stress, worry, or being tired. They cause the muscles of your scalp, neck, and jaw to tighten, and that leads to pain.

The exact cause of migraine headaches is unclear. Your genes and environment, though, are thought to play roles. You get a migraine when certain chemicals in your brain increase. 

Migraine headaches can be brought on by "triggers," which can include changes in your hormone levels or bright lights.

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Treatment for Tension-type Headaches

Occasional tension-type headaches are typically treated with over-the-counter drugs like aspirin (for adults only because of the chance of Reyes Syndrome in children and teens), acetaminophen, ibuprofen, or naproxen. Caffeine also may help. Many headache medicines include caffeine as an ingredient.

If you have chronic tension-type headaches that don't get better with over-the-counter medications, see your doctor. Sometimes doctors prescribe antidepressants to treat these headaches. You don't have to have depression or anxiety for these medications to help your pain.

Acupuncture and self-relaxation techniques may also help ease tension-type headaches.

Treatment for Migraine Headaches

Find out what your triggers are and avoid them. Keep a headache diary so you can track things like what you've eaten and had to drink, how much you've slept, activities you've taken part in, weather, and other factors. After you've had a few migraine headaches, you can see what things they have in common.

You may be able to catch a migraine on the front-end. Abortive medications, which you take as soon as you feel one coming on, can stop the process. Drugstores carry over-the-counter ibuprofen medications specifically for migraine headaches. If they aren't enough to help, your doctor may prescribe stronger medications.

If you don't respond to other treatments and you have more than 4 migraine headache days a month, your doctor may suggest preventive medicines. You can take these regularly to reduce the severity or frequency of the headaches. These include seizure medicines, blood pressure medicines (like beta blockers and calcium channel blockers), and some antidepressants.

It's also possible you will will be prescribed use of a newly approved hand-held called gammaCore. A noninvasive vagus nerve stimulator (nVS), it can be placed on the vagus nerve in the neck to interupt verve signals for migraine relief. Another device called a SpringTMS (Transcranial Magnetic Stimulator) can be used for treatment or prevention or migraines. It is placed on the back of the head and gives off a pulse of magnetic energy into part of the brain to stop or ease pain

CGRP inhibitors are a new class of preventive medicine that your doctor may recommend if other medicines don’t help. A headbandlike device called Celefy provides transcutaneous electrical nerve stimulation which can help prevent migraines from occuring.

Other treatments that may help with migraine symptoms include self-relaxation techniques, acupuncture, hypnosis, yoga, and exercise.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on May 20, 2018

Sources

SOURCES:

NIH Medline Plus: "Headache Symptoms, Diagnosis, and Treatment."

American Migraine Foundation: "Tension-Type Headache," "Living With Migraines."

National Headache Foundation: "Tension-Type Headache," "Migraine," "Biofeedback," "Caffeine: A Little Bit Goes a Long Way."

Migraine Research Foundation: "Migraine Triggers," "Migraine: Non-Drug Treatments."

Linde, K. Cochrane Review, April 2016.

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