Migraine vs Tension Headache: What’s the Difference?
Author: Arome David, BSc, MPH, Fellow – Media EIS
Reviewed by: Dr Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)
Highlights
- A headache is a disabling condition often characterised by pain
- It occurs more frequently in women than men
- The two common primary headaches are tension headaches and migraines
- Triggered by stress and sleep disturbance
- Diagnosed based on the patient's medical history and clinical examination
Managed with drugs like acetaminophen, preventive medications, and lifestyle adjustments.
Introduction
Imagine coming home after a long, exhausting day, hoping for rest and relief. Only to wake up with a pounding headache that persists for days. For many, this is a daily reality. Headache is often neglected, yet a disturbing health challenge in the world today. Despite the impact, many cases go undiagnosed and untreated, especially in low-income and under-resourced communities. Poverty and poor access to healthcare hinder people's access to proper treatment.
What is a Headache?
- A headache is a pain that comes with discomfort in the head and face and varies in severity, type, location and frequency.
Classification of Headaches
According to the International Classification of Headache Disorders (ICHD), headaches are classified into three:
- Primary headaches are usually triggered without any underlying secondary medical condition. Examples: tension headache, migraine.
- Secondary headaches are associated with medical conditions. Examples: tumour-related headaches, medical overdose headaches and headaches due to head injury
- Neuropathies – nerve damage and facial pain conditions that affect any part of the 12 cranial nerves.
This article deals with tension headaches and migraines, the two most common types of primary headaches.
What is Tension Headache?
Tension headaches, also known as tension-type headaches (TTH), are dull, aching pain or tightness like a band around the head that sometimes spreads into or from the neck and is not worsened by regular physical activity [4].
Symptoms of Tension Headache
Common symptoms include:
- Mild to moderate pain across the forehead or side of the head, trouble focusing, and tenderness of the scalp.
- TTH does not come with symptoms like nausea and vomiting, but photophobia (light sensitivity) and phonophobia (sensitivity to sound) may be present.
- It may be caused by stress or problems with bones and muscles in the neck. TTH affects 50% more women than men.
The two common types of TTH
- Episodic TTH
It occurs once in a while, usually on fewer than 15 days per month. Reported by more than 70% of some populations. It can last a few hours, and sometimes can persist for many days
- Chronic TTH
It occurs more often, in most cases 15 days or more per month and sometimes can stay for months, can be unremitting and is more disabling than episodic TTH
What is Migraine?
Migraine is a disabling headache disorder [5], marked by severe, disturbing pain on one side of the head. Over 1 billion people suffer from migraine globally [6]. On many occasions, it begins at puberty and is common among people aged between 35 and 45 years. It is more common in women due to hormonal influences.
Symptoms of Migraine
- Often accompanied by a range of symptoms such as:
- Nausea,
- Vomiting
- Sensitivity to light and sound.
- At times, it is preceded by a short-lasting aura – a sensory disturbance that can affect vision, speech and physical sensation.
- It can last for 4-72 hours.
Common Triggers of Migraine
- Physical activity
- Sleep loss,
- Mental and physical burnout
- Emotional stress [3].
The severe pain from migraines can significantly disrupt daily schedules. The severe pain often leads to absenteeism and reduced performance at the workplace and can lead to depression if left unmanaged.
Differences between Tension Headache and Migraine
This table highlights the key distinction between tension headaches and migraines [7]
How are Headaches Diagnosed?
- Medical history of patients: The doctor asks the patient about the clinical presentation, such as the frequency, duration, intensity and duration of the headache. There are no laboratory tests to diagnose tension headaches and migraines; however, lab tests may be needed to rule out other causes of headaches.
- Imaging Test (Magnetic Resonance Imaging (MRI) or Computed Tomography Scan (CT scans): In some cases, imaging tests may be carried out to possibly rule out potential causes of the headache.
Treatment of Tension Headache and Migraine
Tension Headache
Short Term Treatment
Painkillers like ibuprofen or paracetamol to relieve pain.
Preventive Medications
Preventive medicines are used for regular tension headaches that are not relieved by analgesics. Commonly used are drugs like amitriptyline and mirtazapine [8].
Lifestyle Modifications
Lifestyle modifications that will help manage and prevent tension headaches include stress management, routine exercise, proper posture and patient education.
Home Remedies for Tension Headaches
- Having some rest.
- Placing an ice pack or hot pack on the head and neck.
- Gently stretching the neck.
- Taking deep breaths during relaxation.
Migraine
Short Term Treatment
Mostly used drugs include triptans like sumatriptan, NSAIDs, and anti-emetics.
Preventive Therapies
Use of beta-blockers, anticonvulsants, antidepressants, and CGRP-targeting therapies like fremanezumab.
Lifestyle Adjustments
Avoid migraine triggers such as stress and sleep deprivation. Maintain a regular sleep schedule, practising stress reduction techniques.
Alternative Remedies
Intake of vitamins like riboflavin (Vitamin B2) and minerals such as magnesium.
Non-Drug Approach
Acupuncture, exercise and physical therapy approaches, psychological treatment, biofeedback and diet.
Home Remedies for Migraine
The same remedies that apply to tension headaches may help reduce migraines, but not stop them. Other alternative remedies include:
- Self-relaxation techniques
- Acupuncture
- Hypnosis
- Yoga
- Exercise
Conclusion
Understanding the differences between tension headaches and migraines is important for effective treatment. This requires consulting a health professional for an examination and a tailored treatment plan. Headache, a disturbing human health concern, must not be ignored.
References
1. Stovner LJ, Hagen K, Linde M. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. 2022;23:34. Available at: https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-022-01402-2
2. Adoukonou T, Agbetou M, Dettin E. The prevalence and demographic associations of headache in the adult population of Benin: a cross-sectional population-based study. J Headache Pain. 2024;25:52. Available at: https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01760-z? 3. Aderinto N, Olatunji G, Kokori E. Prevalence, characteristics, and treatment outcomes of migraine headache in Nigeria: a systematic review and meta-analysis. J Headache Pain. 2024;25:172. Available at: https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01869-1
4. Alnaim MMA, Bukhamsin SAA, AlBurayh YA, Alshadly MRS, Almaslamani KWM, Alatawi WLS, et al. Causes and Treatment of Tension Headache: A Review. JPRI. 2021 Dec 13;33(56A):288-93. Available at: https://journaljpri.com/index.php/JPRI/article/view/4668?__cf_chl_tk=H14uqINwMqv49O0Lv5XAvAFwbe8c9I3uxTF1UKP_veY-1747538079-1.0.1.1-1ixxjZserttDiV5SwYhjJuRcw8kRpEPhtGn5Y5ymzzY
5. Eigenbrodt A, Ashina H, Khan S, Diener H, Mitsikostas D, Sinclair A, et al. Diagnosis and management of migraine in ten steps. Nat Rev Neurol. 2021 Aug;17(8):501–14. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8321897/
6. Kalkman DN, Couturier EGM, El Bouziani A, Dahdal J, Neefs J, Woudstra J, et al. Migraine and cardiovascular disease: what cardiologists should know. Eur Heart J. 2023 Aug 7;44(30):2815-28. Available at: https://academic.oup.com/eurheartj/article/44/30/2815/7204852?login=false.7. Onan D, Younis S, Wellsgatnik WD, Farham F, Andruškevičius S, Abashidze A, et al. Debate: differences and similarities between tension-type headache and migraine. J Headache Pain. 2023 Jul 21;24(1):90. Available at: https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01614-08. Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA. 2001 May 2;285(17):2208-15. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2128735
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The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Published June 8, 2025