Tension Headache vs Migraine: What’s the Difference?

Every headache is different.

This isn’t only a subjective thing; there are different types of headaches, including tension headaches, cluster headaches, and migraine headaches.

Knowing the differences between these can help you determine the best ways to treat and prevent head pain.

In this article, we’ll explain the symptoms, causes, and treatments of tension headaches and migraines.

Then we’ll discuss when to see a healthcare provider about headaches..

Symptoms of a Tension Headache

Tension-type headaches are the most common type of headache. Symptoms of tension headaches include:

• Constant pressure or pain across the whole head (not just on one side)
• Feeling like there is a “band” around the head
• Neck or shoulder tension

Symptoms of a Migraine

Migraines are also common, affecting as many as 12% of Americans, and they happen for different reasons.

Migraines are neurological disorders that involve specific changes to the brain before, during, and after a migraine episode.

Migraine symptoms tend to appear in four distinct phases: prodrome, aura, attack, and postdrome.

Some symptoms may occur in multiple migraine stages.

Common migraine symptoms include:

• Pain on one side of the head
• Moderate to severe pain
• Nausea and/or vomiting
• Light sensitivity
• Vision, sound, or motor disturbances
• Neck pain

Causes of Tension Headaches

Tension headaches can be caused by one or more of the following:

• Stress, depression, and/or anxiety
• Alcohol use
• Changes to caffeine intake (either too much or too little)
• Muscular factors like poor posture or neck tension from computer or smartphone use
• Injury
• Teeth grinding or jaw clenching
• Eye strain from computer or smartphone use
• Fatigue
• Overexertion

Tension headaches can happen to anyone of any age, but they are more common in people assigned female at birth.

Causes of Migraines

Migraines are still not fully understood, but several factors likely contribute to the development of migraine episodes, including:

• Genetics
• Sex (people assigned female at birth are more likely to be affected)
• Certain foods such as MSG, red wine, chocolate, and artificial sweeteners
• Sensory overstimulation, like bright lights or loud noises
• Stress or anxiety
• PMS or hormone changes
• Weather changes, like a sudden temperature change or a storm front
• Lack of sleep or too much sleep
• Too much or too little caffeine
• Tobacco or alcohol

Type of migraines

There are different types of migraines.

Some people may experience more than one kind of migraine.

• Acute migraine: This is the type of migraine that people think of when they hear the term “migraine attack”. Also called an episodic migraine, this may happen infrequently or up to 14 times per month.

• Chronic migraine: This type of migraine has the same presentation as an acute migraine but occurs more frequently. People who experience chronic migraine usually have 15 or more migraine episodes per month.

• Hemiplegic migraine: This rare type of migraine is sometimes called a complex migraine. It does not have all the typical migraine symptoms and may cause stroke-like symptoms. Seek emergency medical care if you notice weakness or numbness on one side of the body or have trouble speaking.  It is important that you not assume you have this type of migraine unless diagnosed by a healthcare professional.

• Ocular migraines: This less-common type of migraine includes typical migraine symptoms along with changes to vision, which may include the loss of vision in one eye. If you experience signs of ocular migraine (sometimes called retinal migraine), seek emergency medical care to rule out a more serious underlying cause.

Treatment for Tension Headaches

Tension headaches can go away on their own, but treatment may shorten the duration.

Medications

The type of medication used for treating tension headaches depends on the severity of symptoms and other factors, such as how often headaches occur.

• Over-the-counter pain relievers: Acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve) may help. Or combination OTC pain medicines like Excedrin (which pairs pain relief with caffeine) or Tylenol PM (which pairs acetaminophen with a sedative) may be recommended if tension headaches make it hard to function during the day or affect sleep quality.  Only use one of these medications at a time.

• Additional medications: Tricyclic antidepressants, anticonvulsants, or muscle relaxers may help decrease the severity of tension headaches or prevent them from occurring.  These medications should be prescribed by a healthcare provider.

Self-care

At-home remedies may help increase the effectiveness of medication or decrease the need for medication when you have a tension headache. These therapies include:

• Rest
• Hot shower or bath to relax muscles
• Heating pads
• Ice
• Relaxation techniques
• Stress management
• Proper posture training
• Aromatherapy

Therapies

In addition to medication and self-care, the following therapies may help treat tension-type headaches:

• Massage therapy
• Chiropractic adjustments
• Acupuncture
• Acupressure

Treatment for Migraines

Migraine treatment depends on your migraine type, specific triggers, how often you experience migraine attacks, and other health conditions.

A healthcare provider can help you pinpoint effective strategies and medications.

Everyone responds differently, so continue to work with your healthcare provider to identify what works best for you.

Medications

There are several medication options for migraine treatment.

• OTC pain relief: Acetaminophen (Tylenol), naproxen (Aleve), ibuprofen (Advil, Motrin), and Excedrin.

• Prescription pain relief: Triptans, anti-nausea drugs, muscle relaxers, and other various migraine specific prescription medications

• Preventive medications: Anticonvulsants, certain antidepressants, beta-blockers, CGRP antagonists, calcium channel blockers, and Botox injections.

Self-care

There are many things you can do at home to address migraine pain:

• Take a nap
• Use relaxation techniques (such as deep breathing or meditation)
• Use a cool compress on your head
• Drink water
• Rest in a dark room
• Take a warm shower or bath to relax muscles
• Avoid food triggers

Therapies

The following therapies that promote stress relief may also help prevent and manage migraine:

• Cognitive-behavioral therapy
• Biofeedback
• Meditation
• Yoga

When to See a Healthcare Provider

Home treatments and OTC medication are often enough to manage tension headaches.

Prescriptive migraine treatments are known to generally be effective as well. 

However, seek medical attention if you experience:

• A headache that is different from your normal headaches
• A sudden, severe headache or the worst headache of your life
• Head pain after a fall or injury
• Numbness to the body or paralysis on one side of the body
• Headache that doesn’t improve or worsens with OTC treatment
• Confusion or altered level of consciousness 
• Seizure activity
• Vision changes or vision loss
• Dizziness or feeling like you are going to pass out

The presence of other symptoms such as a fever or neck stiffness

Not all headaches are migraines or tension headaches.

Your healthcare provider can diagnose the cause of your headaches, which can help you find effective ways to manage and treat them.

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