From the Guidelines
Tension headaches and migraines are distinct types of headaches with different characteristics and treatment approaches, with tension headaches typically causing mild to moderate pain and migraines causing more severe, intense, throbbing pain often accompanied by additional symptoms. The main difference between tension headaches and migraines lies in their symptoms, duration, and treatment options. Tension headaches usually cause mild to moderate pain that feels like a tight band around the head, affecting both sides, and develop gradually, lasting from 30 minutes to several days with rare additional symptoms beyond the head pain 1. In contrast, migraines are more severe, causing intense, throbbing pain typically on one side of the head, frequently including additional symptoms such as nausea, vomiting, and sensitivity to light and sound, and may be preceded by an aura, lasting from 4 to 72 hours if untreated 1. For tension headaches, over-the-counter pain relievers like acetaminophen or ibuprofen at standard doses are usually effective, while migraines often require specific medications such as triptans for acute attacks and preventive medications like topiramate, propranolol, or newer CGRP inhibitors for frequent occurrences 1. The difference in symptoms and treatment stems from their different mechanisms, with tension headaches involving muscle tension and stress, and migraines involving neurovascular changes with abnormal brain activity and inflammation of blood vessels. Key considerations for distinguishing between tension headaches and migraines include the location and character of the pain, the presence of additional symptoms, and the duration of the headache, as well as the patient's medical history and response to treatment 1. Overall, accurate diagnosis and treatment of tension headaches and migraines are crucial to improving patient outcomes and quality of life, and healthcare providers should consider the latest clinical guidelines and evidence-based recommendations when managing these conditions 1.
From the Research
Differences between Tension Headache and Migraine
- Tension headache and migraine are two distinct primary headache disorders with different clinical characteristics, as noted in 2.
- Migraine is typically identified by specific features such as being more prevalent in females, being aggravated by physical activity, and having photophobia, phonophobia, nausea, vomiting, or aura, whereas tension-type headache is characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity, as described in 3.
- The pathophysiology of both conditions involves the trigeminovascular system, but distinguishing between them can be challenging due to the lack of specific diagnostic tests and biomarkers, as discussed in 2.
Epidemiology and Burden
- Tension-type headache is the most prevalent neurological disorder worldwide, affecting 78% of the general population, as reported in 4.
- Migraine is also highly prevalent and associated with significant work- and family-related disability, as noted in 5.
- Both conditions have a substantial societal and individual burden, with chronic tension-type headache differing from the episodic form in frequency, lack of effect to most treatment strategies, more medication overuse, and more loss of quality of life, as described in 4.
Treatment Options
- First-line acute treatment for migraine consists of analgesics, triptans, and antiemetics, while nonsteroidal anti-inflammatory drugs are the mainstay treatment for tension-type headache, as stated in 6.
- Preventive treatment options for migraine include various classes of preventives, such as β-blockers, tricyclics, antiepileptics, and botulinum toxin, whereas tricyclics have the most evidence as prophylactic therapy for tension-type headache, as discussed in 6.
- Simple analgesics have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of tension-type headache, as noted in 3.