Migraine Headache or Tension: What’s the Difference?

People often mistake tension headaches for migraines. Understanding the difference between the two types of headache matters. You want to apply the right prevention methods and treatment.

Migraine Vs Tension Headache

Very often patients come into the office and tell me they have a “migraine headache”. A migraine headache is a very specific type of headache, and the term is most often used incorrectly to refer to a severe headache.

Probably the most common headache, and the one we will be discussing, is called a “tension-type headache”. Tension headaches usually are not associated with classical migraine headache symptoms such as nausea, vomiting, increased pain with physical exertion, and light or noise do not generally affect the headache.

Typical differences described: Tension-type headache is commonly a steady, pressure-like pain on both sides of the head, while migraine is often one-sided and throbbing, commonly with nausea and sensitivity to light or sound, and it may worsen with routine activity. International Headache Society (ICHD-3): Migraine without aura (diagnostic criteria).

About Tension Headaches

As many as 80% of women and 69% of men experience a tension-type headache in their lifetime. As the name implies, tension-type headaches may be directly attributed to tension or stress. It is no wonder that this type is the most common type of headache.

Tension headaches generally refer to a condition characterized by bilateral (both sides of the head) mild to moderate pain, and pressure often described as wearing “a vice around my head”.

Cost of Tension-Type Headaches

Because of its high prevalence, tension-type headaches has greater socioeconomic impact than any other headache type. For every 1000 people, about 820 annual work days are lost on account of tension-type headaches, versus 270 days for migraine headache.

The reduced productivity of those who remain at work, despite the headache, has an even greater impact! Tension-type headaches have a negative effect on one’s emotional life, resulting in marked reduction in quality of life and frequently on social and family activities.

Treatment for Tension Headaches

Management of tension-type headache varies by person. Medications sometimes used under medical guidance include:

• simple analgesics
• simple analgesics with caffeine
• non-steroidal anti-inflammatory medications, such as aspirin and Ibuprofen
• muscle relaxants, in combination with, or without, any of the above medications.

Non-pharmacologic approaches include:

A. Regulation of lifestyle

• a regular sleep schedule
• meals at consistent times each day
• regular exercise
• attention to possible dietary triggers.

B. Minimise emotional stressors

• planning ahead to reduce stressful situations
• time set aside for relaxation
• meditation practices.

C. Avoid environmental triggers

• sunglasses in bright light
• limiting exposure to smoke, perfumes, strong odors and loud noises
• reducing heavy traffic exposure when possible.

D. Other important factors

• a comfortable work area
• good posture

People who work at a desk or computer often notice relief when they take breaks, stand and move about, turn their head from side to side, look around the room, and roll their shoulders to avoid staying in an uncomfortable position.

For some individuals, tension-type headaches are associated with ongoing stress in daily life. Supportive conversations, relaxation time, or counselling may be discussed with a professional when stress feels overwhelming.