Understanding the Basics
Tension headaches and migraines are two of the most common primary headache disorders worldwide, affecting hundreds of millions of people every year. Yet telling them apart can be challenging. Both can cause significant head pain and disrupt daily life, but they differ in their symptoms, triggers, and management approaches. Recognising these differences can help you seek the right care sooner and avoid unnecessary discomfort.
What is a Tension Type Headache?
Tension headaches, also known as tension-type headaches, are typically characterised by mild to moderate pain that feels like a tight band around the head. The International Headache Society classifies them as primary headache disorders, with two main types: episodic tension-type headaches and chronic tension-type headaches.
Common tension headache symptoms include:
- Aching pain on both sides of the head
- Muscle tenderness in the neck and shoulder muscles
- Pressure or tightness across the forehead or scalp
- Mild to moderate pain severity
Tension headaches are often triggered by stress, poor posture, eye strain, or muscle contractions in the head and neck. Lifestyle changes, stress management techniques, and physical therapy can help prevent tension headaches and reduce headache frequency.
What is a Migraine?
Migraines are a neurological disorder involving recurrent migraine headaches. They often cause severe pain that is pulsating or throbbing. They typically affect one side of the head and may come with light sensitivity, mild nausea, visual disturbances, and cognitive changes.
Typical migraine triggers include:
- Hormonal changes
- Certain foods or drinks
- Stress or sudden relaxation after stress
- Changes in sleep patterns
Migraines can be episodic or chronic, with chronic migraine defined as headaches occurring on 15 or more days per month. Preventive medications and targeted treatment plans can reduce migraine attacks and improve the quality of life for migraine sufferers.
Migraine vs Tension Headache – Key Differences
Spotting the difference between a tension headache and a migraine can save you time, frustration, and unnecessary discomfort. While they share some overlapping symptoms, the way they feel, how long they last, and the extra signs that appear alongside the headache pain can help point you in the right direction. Use the guide below to get a clearer picture. Remember that only a professional assessment can confirm your headache type and set you on the best path to relief.
Pain Quality
- Tension Headache: Dull, aching pain that feels like a tight band around the head.
- Migraine: Throbbing or pulsating pain that can intensify with movement.
Pain Severity
- Tension Headache: Mild to moderate pain that allows most daily activities.
- Migraine: Moderate to severe pain that can be disabling.
Pain Location
- Tension Headache: Usually on both sides of the head.
- Migraine: Often affects one side of the head, but can shift or occur on both sides.
Other Symptoms
- Tension Headache: Muscle tenderness in the scalp, neck, and shoulder muscles; no nausea or visual disturbances.
- Migraine: Nausea, vomiting, light sensitivity, and sometimes visual disturbances (aura).
Duration
- Tension Headache: 30 minutes to several days.
- Migraine: 4 to 72 hours.
Common Triggers
- Tension Headache: Stress, poor posture, eye strain, fatigue.
- Migraine: Stress, certain foods, hormonal changes, weather changes, sensory triggers (light, sound, smell).
Understanding these patterns can help guide more effective treatment choices.
A Handy Way to Spot a Migraine: The POUND Mnemonic
One quick tool doctors may use to help identify a migraine is the POUND mnemonic. Each letter represents a key symptom often seen with migraines:
- P – Pulsating pain
- O – One-day duration (4–72 hours)
- U – Unilateral (one-sided) pain
- N – Nausea or vomiting
- D – Disabling intensity
If you experience several of these symptoms, it could point towards migraine rather than a tension headache. While this guide can be useful, it’s not a substitute for a professional diagnosis, especially since many people experience a mix of headache symptoms. For additional support, you can also use this fast, free “Diagnose My Headache” tool here.
Can a Tension Headache Become a Migraine?
While a tension headache does not directly transform into a migraine, it is possible for someone to experience both migraine and tension headaches. Chronic tension-type headaches may increase overall headache frequency, which can contribute to medication overuse headache or rebound headaches. These conditions can worsen symptoms over time.
Diagnosis and Treatment
Accurately identifying your headache type involves a detailed history, headache diary review, and a thorough assessment following the guidelines of the headache classification committee. In some cases, tests may be used to rule out other neurological disorders.
Treatment options include:
- Pain relief with over-the-counter or prescription pain medicine (but this does not identify the cause or how to manage it)
- Preventive treatment to reduce headache frequency
- Physical therapy for muscle tension
- Cognitive behavioural therapy and relaxation techniques
- Stress management techniques such as deep breathing and physical activity
At Brisbane Headache & Migraine Clinic, proven and medication-free treatment plans are tailored to each patient’s headache pattern, risk factors, and lifestyle, with a focus on both immediate relief and preventive care.
Prevention and Long-Term Management
You can help prevent tension headaches and migraines by:
- Maintaining good posture
- Staying hydrated
- Managing stress with relaxation techniques
- Following a healthy lifestyle
- Keeping a headache diary to track common triggers
Preventive medications, lifestyle changes, and education can help headache sufferers achieve better long-term results.
When to Seek Professional Help
Seek urgent medical advice if you experience:
- Sudden severe headache
- Headache after a head injury
- Changes in headache pattern
- Neurological symptoms such as confusion or weakness
Understanding Your Headache and Taking Control
While tension headaches and migraines share some symptoms, recognising the differences is key to finding the most effective treatment approach. If you are unsure about your headache type or are struggling with chronic tension or migraine headaches, the team at Brisbane Headache & Migraine Clinic can help identify the root cause of your headaches and create a personalised treatment plan tailored to your needs.
Book a consultation with our team today.
Tension Headache vs Migraine – FAQs
Can migraine pain feel like a tension headache?
Yes. Some migraine headache sufferers experience mild symptoms that resemble tension headaches, making diagnosis challenging without a professional assessment.
Can a chronic tension-type headache become a migraine?
No, a chronic tension-type headache can’t transform into a migraine, as they are two distinct primary headache disorders. However, it’s possible for someone to experience both conditions.
In some cases, a person who has chronic tension headaches might also have occasional migraines. If your headache patterns change and you begin experiencing migraine symptoms like a pulsating headache, sensitivity to light, or nausea, it’s essential to get a new diagnosis to rule out other primary headache disorders and ensure you’re getting the correct treatment.
Can I have chronic migraines and also get an occasional headache?
Yes, it’s very common for people with chronic migraines to also experience other types of headaches. A person with chronic migraines, which are defined as having headaches for 15 or more days a month, can still have an occasional headache that isn’t a migraine. These other headaches might be tension-type headaches, which typically feel like a dull pressure. A migraine attack, in contrast, is usually characterised by more specific symptoms like a severe, throbbing pain, often on one side of the head, and other symptoms like light sensitivity or nausea.
Do tension headaches last longer than migraines?
Tension headaches can last from 30 minutes to several days, while migraines usually last 4–72 hours, but can sometimes be longer in chronic migraine cases.
How can I tell if my headache is serious?
If your headache is sudden, severe, or accompanied by neurological symptoms, seek urgent medical attention. Serious symptoms include headache pain that feels like the “worst ever,” or if the pain is accompanied by a stiff neck, high fever, or confusion. Also, be wary if your headache is so intense that it’s causing pulsating pain and an unbearable sensitivity to light that’s completely new to you. These can be signs of a more severe underlying issue.
References
Onan, D., Younis, S., Wells, G. N., Farham, F., Andruškevičius, S., Abashidze, A., … Martelletti, P., & Ashina, S. (2023). Debate: differences and similarities between tension-type headache and migraine. The Journal of Headache and Pain, 24, 92. https://doi.org/10.1186/s10194-023-01614-0
Stovner, L. J., Nichols, E., Steiner, T. J., et al. (2018). Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 17(11), 954–976. https://doi.org/10.1016/S1474-4422(18)30322-3
Burch, R., & Rayhill, M. (2023). Diagnosis and management of headache: a review. JAMA, 329(7), 558–568. https://jamanetwork.com/journals/jama/fullarticle/2779823
