Tension Headache vs. Migraine: What Are the Differences?

There are many different types of headaches, each with its own sensations such as a sharp, pulsing, or throbbing pain. Two of the most common types of headaches are tension headaches and migraines.

The pain of a tension headache is dull and happens on both sides of the head. You may feel tightness or pressure in your head. Migraines, on the other hand, occur on only one side or are worse on one side. They are characterized by a severe throbbing or pulsing pain.

In this article, we'll discuss the similarities and differences between tension headaches and migraines in symptoms, causes, and treatments.

Symptoms

Migraines and tension headaches are considered primary headaches, which means they are not caused by another condition. A headache caused by an underlying condition is known as a secondary headache.

While both migraines and tension headaches cause pain in your head, the pain each causes is different and they may be accompanied by different symptoms.

There can also be some overlap between the symptoms of a migraine and a tension headache; for example, while most people who get migraines experience one-sided head pain, there are people who get pain that is on both sides of their head (which is more common in tension headaches).

Migraines can occur after a prodrome, which are symptoms that begin a few hours before the headache comes on. Prodrome symptoms can include:

• Fatigue
• Depression
• Irritability
• Food cravings
• Muscle and neck stiffness or tenderness

Some people also experience migraine auras, which can happen prior to or during a migraine. Symptoms of migraine auras can include:

• Visual disturbances, such as not being able to see, seeing stars, or seeing blind spots in your vision
• Problems with speech or language
• Numbness or tingling in one hand or side of the face
• Weakness in your muscles or loss of balance

Just over 30% of people who suffer from migraines also experience migraine auras. People who get tension headaches do not experience auras or prodromes.  

Causes

The cause of migraines and tension headaches isn't fully understood. Tension headaches were previously thought to be caused by contraction of the neck and scalp muscles, but researchers have found that not to be true.

Researchers believe that migraines may have a genetic component. A migraine starts in the nerves in the brain, which then send signals to nerves like the trigeminal nerve, a part of the nervous system responsible for sending pain, touch, and temperature sensations from your face to your brain, and it begins to affect the blood vessels.

Although the direct cause of both types of headaches isn't clear, they have some common triggers, such as:

• High levels of stress
• Lack of sleep
• Skipping meals or not eating enough
• Alcohol use
• Female sex hormone fluctuations

Migraines can also be brought on by weather changes that cause the barometric pressure to drop. Barometric pressure is the pressure of the air in the atmosphere, and it typically drops prior to rain and rainstorms.

Hormones

Female hormones play a significant role in the development of headaches, which is why women tend to experience head pain more often than men. Research has shown that children of both sexes have similar rates of headaches. However, when female children hit puberty, they begin to experience headaches significantly more than male children.

It is thought that fluctuations in estrogen set off a series of chemical reactions in the brain that trigger headaches, specifically migraine attacks. Researchers do not know the exact reason why this happens.

Diagnosis

If you are experiencing chronic tension headaches or migraines, you should see a neurologist to find out the cause.

Migraine

Your doctor will ask about your symptoms and take a detailed health history. Signs that could prompt your neurologist to order brain scans include seizures, loss of consciousness, or cognitive issues, such as poor memory or coordination.

Typical brain scans include a CT scan, which uses X-rays to see inside the brain in better detail, or an MRI, which uses magnetic forces to formulate a more in-depth picture of the inside of the brain.

Tension Headache

Tension headache diagnosis involves the same clinical process, but they are often diagnosed based on the absence of symptoms that occur with other types of headaches.

Your doctor will take note of your symptoms and pain levels. If they have reason to believe something else is at play, they will order an MRI or CT scan to investigate further.

Treatment

Getting a proper diagnosis for a tension headache or migraine is crucial because treatments vary between the two.

Tension Headaches

The first-line treatment for tension headaches is over-the-counter (OTC) pain relievers such as Tylenol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen). People with chronic or recurrent tension headaches may be prescribed amitriptyline, an antidepressant.

Migraines

There are two main types of medications used to treat migraines:

• Abortive medications: These are most effective when you use them at the first sign of a migraine. Take them while the pain is mild. By possibly stopping the headache process, abortive medications help stop or reduce your migraine symptoms, including pain, nausea, and light sensitivity. Some abortive medications work by constricting your blood vessels, bringing them back to normal and relieving the throbbing pain.
• Preventive (prophylactic) medications: These may be prescribed when your headaches are severe, occur more than four times a month, and are significantly interfering with your normal activities. Preventive medications reduce the frequency and severity of your headaches. Medications are generally taken daily to help prevent migraines.

Other treatments for migraines include:

• Trigger management: Eliminating or avoiding triggers such as missing meals or not getting enough sleep can help treat chronic migraines.
• Transcranial magnetic stimulation (TMS): TMS sends brief pulses into the brain via electromagnetic waves to activate or suppress activity in the brain that’s causing your migraine.
• Vagal nerve stimulation: Vagal nerve stimulation sends electricity to the vagus nerve, which is the longest nerve in the body. It runs from the brain, through the face, and into the abdomen. Vagal nerve stimulation can reduce the frequency of migraine attacks.

Prevention

Prevention of migraines and tension headaches involves avoiding triggers. Triggers such as lack of sleep and not eating can be easily remedied by ensuring that you don’t skip meals and are getting enough sleep every night.

If you are not sure what your triggers are, you can monitor them using a diary or journal. You can keep track of environmental changes, the foods you eat, and life experiences that come before the tension headache or migraine starts.  

Some things such as weather changes or hormonal fluctuations are unavoidable, but you can pay attention to when those changes are going to occur and plan accordingly. You can make sure you have the medication you need on hand, and begin treatment when symptoms start.

You can also prevent migraines by maintaining a healthy lifestyle:

• Get seven to nine hours of sleep a night.
• Eat at regular intervals. Don't skip meals, and drink plenty of water.
• Exercise regularly and maintain a healthy weight.
• Learn techniques to control stress, such as meditation, yoga, relaxation training, or mindful breathing.
• Take medications as directed by your healthcare provider.
• Talk to your healthcare provider about hormone therapy if your migraines are thought to be linked to your menstrual cycle.
• Get counseling from a therapist for help in controlling your stress.
  

Summary

While tension headaches are more moderate, migraines can be so severe that they hinder your ability to participate in daily activities. Migraines and tension headaches are treated using pain relievers, but other forms of treatment can also be used. The one thing everyone with tension headaches and migraines should do is keep track of triggers so that they can avoid or eliminate them when possible. That will go a long way toward managing and preventing your headaches.

A Word From Verywell

Dealing with chronic head pain from either a tension headache or a migraine can be difficult. The good news is that there are things you can do to manage and cope with tension headaches and migraines.

Medical treatment and lifestyle changes can help you reduce the frequency, duration, and severity of tension headaches and migraines. The most important thing to remember is that you have some control of your headaches. You can keep track of your triggers and take your pain medications at the first sign of symptoms.