Tension Headache vs. Migraine: What Are the Differences?

Table of Contents
View All
Table of Contents

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.

Stressed woman rubbing her forehead at laptop

JGI / Jamie Grill / Getty Images

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).

Migraine
  • Intense or severe pain that is worse on one side or occurs only on one side

  • Pressure and pain behind the eyes

  • Pain in the temples

  • Nausea and vomiting

  • Pain that worsens with physical activity

  • Sensitivity to light, sounds, or smells

  • Dizziness

Tension Headache
  • Moderate pain that occurs on both sides of the head

  • Tight pressure in the head

  • A feeling like your head is being squeezed

  • Soreness in the temples

  • Pain in the neck or shoulders

  • Tightness in the neck or shoulders

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.  

Recap

Tension headaches and migraines present with some similar symptoms, but the severity and type of pain felt are different. Migraines also present with other symptoms, such as nausea and sensitivity to light and sound, and may or may not come with a prodrome or aura.

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.

Recap

The exact cause of tension headaches and migraines isn't clear, but the two conditions can be brought on by the same triggers. Women are affected by migraines more than men because fluctuations in female sex hormones contribute to headaches.

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.

Recap

The diagnostic process for both migraines and tension headaches is similar. Your doctor will typically perform physical exams and take a detailed history. If a doctor suspects there could be a chance that an underlying health condition is causing your headaches, they may order brain scans.

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.

Recap

Treatment for tension headaches and migraines is similar, and involves the use of pain relievers. Other forms of therapy can be done to either further alleviate pain or replace pain relievers.

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. 

Frequently Asked Questions

  • What is a tension migraine?

    A tension migraine is a type of headache that has characteristics of both a tension headache and a migraine. These types of headaches will have symptoms of both conditions, such as pain on one or both sides of the head that worsens with activity, nausea and/or vomiting, light and sound sensitivity, neck pain, fatigue, and depression.

  • What are the signs of a migraine?


    Migraines typically begin as a dull ache. As they progress, the pain begins to turn into a pulsing or throbbing pain that continues to get worse over time. If left untreated, the pain will become so severe that it will interrupt your daily activities. Although the pain is sometimes restricted to only one side of the head, it can be felt in the whole head. Some other signs of a migraine that don’t typically occur in other types of headaches include nausea and vomiting, feeling dizzy, blurred vision, and severe sensitivity to light, noise, or smells. Many people with migraines also experience an aura before the pain starts, and it might continue while they are having a migraine.  

  • What triggers a tension headache and a migraine?

    Both migraines and tension-type headaches have the same triggers. They can include not eating, not getting enough sleep, drinking alcohol, high levels of stress, and female sex hormone fluctuations. 

  • How long do migraines last?

    The typical migraine will last about four hours. However, if it is not treated, a migraine can last up to three days. If you have never experienced a migraine before and yours is not going away after taking over-the-counter pain medication, you should see your doctor immediately. Severe head pain that comes on suddenly and isn’t relieved by pain relievers could be a sign of a serious health condition and requires emergency care. If you suffer from chronic migraines and are dealing with one that will not go away, do your best to rest and take your medication but also make an appointment with your doctor. They will likely reexamine the treatment you are currently using and possibly investigate an underlying cause.

  • What can quickly get rid of a headache?

    The medication of choice for headaches is either Tylenol or NSAIDs such as Advil or Motrin. Prior to taking any new medication, you should speak to your doctor to make sure it is safe for you. Home remedy options that can help relieve the pain of a migraine or a tension headache fast include ice packs, lavender essential oil, and sleeping it off.

Was this page helpful?
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ahmed F. Headache disorders: differentiating and managing the common subtypes. Br J Pain. 2012 Aug;6(3):124-132. doi:10.1177/2049463712459691

  2. Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci. 2015 Apr 29;35(17):6619-6629. doi:10.1523/JNEUROSCI.0373-15.2015

  3. Wang J, Zhang B, Shen C, et al. Headache symptoms from migraine patients with and without aura through structure-validated self-reports. BMC Neurol. 2017 Oct 12;17(1):193. doi:10.1186/s12883-017-0973-4

  4. Viana M, Tronvik EA, Do TP, et al. Clinical features of visual migraine aura: a systematic review. J Headache Pain. 2019 May 30;20(1):64. doi:10.1186/s10194-019-1008-x

  5. Hansen JM, Charles A. Differences in treatment response between migraine with aura and migraine without aura: lessons from clinical practice and RCTs. J Headache Pain. 2019 Sep 6;20(1):96. doi:10.1186/s10194-019-1046-4

  6. May A. Hints on Diagnosing and Treating Headache. Dtsch Arztebl Int. 2018 Apr 27;115(17):299-308. doi:10.3238/arztebl.2018.0299

  7. U.S. National Library of Medicine. Migraine. Updated August 31, 2021.

  8. Marmura MJ. Triggers, Protectors, and Predictors in Episodic Migraine. Curr Pain Headache Rep. 2018 Oct 5;22(12):81. doi:10.1007/s11916-018-0734-0

  9. Chowdhury D. Tension type headache. Ann Indian Acad Neurol. 2012 Aug;15(Suppl 1):S83-8. doi:10.4103/0972-2327.100023

  10. Al-Hassany L, Haas J, Piccininni M, et al. Giving Researchers a Headache - Sex and Gender Differences in Migraine. Front Neurol. 2020 Oct 22;11:549038. doi:10.3389/fneur.2020.549038

  11. Weatherall MW. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis. 2015 May;6(3):115-123. doi:10.1177/2040622315579627

  12. Cleveland Clinic. Migraine headaches. Updated March 3, 2021.

  13. Ha H, Gonzalez A. Migraine Headache Prophylaxis. Am Fam Physician. 2019 Jan 1;99(1):17-24.

  14. Informed Health. Migraine: Overview. Updated May 30, 2018.

  15. Sasannejad P, Saeedi M, Shoeibi A, et al. Lavender essential oil in the treatment of migraine headache: a placebo-controlled clinical trial. Eur Neurol. 2012;67(5):288-291. doi:10.1159/000335249

  16. Bigal ME, Hargreaves RJ. Why does sleep stop migraine?. Curr Pain Headache Rep. 2013 Oct;17(10):369. doi:10.1007/s11916-013-0369-0.