Difference Between Headache and Migraine
Migraine is a specific neurological disorder characterized by recurrent attacks of moderate to severe throbbing headache with specific diagnostic criteria, while a headache is a broader term that encompasses any pain in the head region, including tension-type headaches which have different characteristics. 1
Key Differences
Diagnostic Criteria
Migraine
- Duration: Typically lasts 4-72 hours untreated 2, 1
- Pain characteristics: At least 2 of the following 2, 1:
- Unilateral location
- Pulsating/throbbing quality
- Moderate to severe intensity
- Aggravation by routine physical activity
- Associated symptoms: At least 1 of the following 2, 1:
- Nausea and/or vomiting
- Photophobia (sensitivity to light) AND phonophobia (sensitivity to sound)
- Frequency requirement: At least 5 attacks fulfilling criteria for diagnosis 2
Tension-Type Headache
- Duration: 30 minutes to 7 days 2, 1
- Pain characteristics: At least 2 of the following 2, 1:
- Pressing/tightening (non-pulsatile) quality
- Mild to moderate intensity
- Bilateral location
- No aggravation with routine activity
- Associated symptoms 2, 1:
- No nausea or vomiting (may have anorexia)
- No combination of both photophobia and phonophobia (may have one or the other)
Types of Migraine
- Most common type
- No warning symptoms before headache onset
- Includes reversible neurological symptoms (visual, sensory, speech/language, motor, brainstem, or retinal)
- Aura typically develops gradually over 5+ minutes
- Each aura symptom lasts 5-60 minutes
- Headache follows within 60 minutes of aura
Chronic migraine 1:
- Headache occurring ≥15 days/month for >3 months
- Fulfills migraine criteria on ≥8 days/month
Pathophysiology
Migraine: Complex neurovascular disorder involving 3, 4, 5:
- Trigeminovascular system activation
- Release of inflammatory neuropeptides (e.g., CGRP)
- Cortical spreading depression (particularly in migraine with aura)
- Neurogenic inflammation
- Brainstem dysfunction
Tension-type headache: Generally considered to involve 1:
- Muscle tension
- Stress-related mechanisms
- Central pain processing abnormalities
Clinical Implications
Treatment Approaches
Acute Treatment
Migraine: Often requires specific medications 1, 6:
- NSAIDs (ibuprofen, naproxen sodium, aspirin)
- Triptans (for moderate to severe attacks)
- Anti-emetics
- Combination analgesics
Tension-type headache: Generally responds to 1:
- Simple analgesics (acetaminophen)
- NSAIDs
- No specific anti-migraine medications typically needed
Preventive Treatment
Migraine: May require preventive medications when frequent (>2/week) 1, 7:
- Beta-blockers
- Anticonvulsants (topiramate)
- Antidepressants
- OnabotulinumtoxinA (for chronic migraine)
Tension-type headache: Preventive approaches focus on 1:
- Stress management
- Physical therapy
- Amitriptyline (for chronic tension-type headache)
Common Pitfalls and Caveats
Misdiagnosis: Migraine is often misdiagnosed as sinus headache or tension-type headache 1, 7
Medication overuse: Both headache types can transform into medication overuse headache if acute medications are used >2-3 days/week 1
Comorbidity: Migraine and tension-type headache can coexist in the same patient, complicating diagnosis 1
Undertreatment: Migraine is frequently undertreated due to misdiagnosis or inadequate therapy 7
Red flags: Important to recognize warning signs requiring further investigation in any headache 1:
- Thunderclap onset
- New onset after age 50
- Abnormal neurological examination
- Headache awakening patient from sleep
- Headache worsened by Valsalva maneuver
- Associated fever or neck stiffness
Understanding these differences is crucial for proper diagnosis and management, as treatment approaches differ significantly between migraine and other headache types.