Understanding Migraine and Tension Headaches


Jennifer Larson

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When your head is killing you, you might not care too much about the specific cause.

But understanding the differences between—and the triggers for—two major culprits for your aching head can also help you handle or treat the pain in the most effective manner.   

The tension is building.

If you’ve ever felt like someone wrapped a tight band around your head, you’ve experienced the signature symptom of a tension headache. Tension headaches are common, accounting for roughly half of all headaches. Misery may love company, as the old expression goes, but that may be very little comfort when you’re experiencing one. With a tension headache, you feel pain all over your entire head, and your neck or shoulder muscles might get into the act and ache, too. The pain can range from mild to moderate, and it can seem to arise out of nowhere, with no obvious warning signs.

However, there are some common triggers, which can include:

  • Stress

  • Fatigue or lack of sleep

  • Anxiety or depression

  • Poor posture.

Fortunately, treatment for most tension headaches is fairly straightforward.

  • Relief of pain. Most doctors will recommend taking a nonprescription pain killer like ibuprofen, aspirin or naproxen. Caution: if you tend to get tension headaches frequently, you should consult your doctor because those nonprescription pain killers, especially the ones containing caffeine, can cause rebound headaches if you take them too often.

  • Prevention of recurrence. If you have chronic tension headaches, your doctor might recommend some combination of stress reduction strategies, cognitive behavioral therapy, biofeedback and medication. The drug therapy component typically involves an antidepressant, or possibly a muscle relaxer or anticonvulsant.

Shhhhh. I’ve got a migraine.

If you’ve ever been forced to retreat to a silent dark room to lie down to wait out a migraine headache, you know how serious a migraine can be. Migraines are less common than tension headaches, but the pain is usually more severe. In fact, a word commonly associated with migraines is “debilitating.”

Classic hallmarks of a migraine include:

  • Intense or throbbing pain

  • Pain on just one side of the head (although it can affect both sides)

  • Nausea, which may also include vomiting

  • Sensitivity to sound and light

Some people also see flashing lights or lines about 10 to 30 minutes before the head pain sets in. This is called “migraine with aura,” and it can also include numbness in the face or hands and an altered sense of smell or taste.

Migraines disproportionately affect women—they’re three times more common in women than in men, according to the National Institute of Neurological Disorders and Stroke. Fluctuations in estrogen levels during the menstrual cycle seems to be responsible for many of those cases. However, migraines can affect people of all ages, including children.

Treatment can vary, but your doctor may want to try a combination of strategies, which can include preventive medicine, acute treatment and stress reduction techniques. Prophylactic medications typically involve an antidepressant, an antiepileptic medication, or an antihypertensive drug, all of which contain active ingredients that attempt to prevent headaches from coming on or lessen their intensity once they do set in. You will also need a pain reliever to use as acute treatment for a headache in progress. For some people, regular over-the-counter pain relievers like ibuprofen or aspirin may do the trick, but others may need a stronger drug, such as the prescription medication called indomethacin. Some people also find relief from the category of drugs called triptans, which work by blocking the pain pathways in the brain. Finally, you may want to experiment with stress reduction techniques—maybe it’s yoga, or walking, or deep breathing exercises—to find one that works for you.

Could it be something else?

Sure. You could also experience a cluster headache or a sinus headache.

The sharp, penetrating pain of a cluster headache can seemingly come of nowhere, even waking you up out of a sound sleep. And it can be as painful and exhausting as a migraine. However, unlike a migraine, the onset of a cluster headache doesn’t seem to be related to hormone levels or exposure to certain foods or stress—instead, your biological clock, which is located in your hypothalamus deep inside your brain, seems to be the culprit. These headaches seem to follow a pattern, occurring at the same time of day, and that pattern can last for weeks.

Meanwhile, sinus headaches tend to show up as a dull, throbbing pain in your face, which may be very tender, or the front of your head. It’s easy to confuse them with tension headaches, but they tend to be caused by clogged sinuses or perhaps a respiratory infection in your sinuses. Allergies can also cause your sinuses to get blocked, allowing bacteria to flourish and keep your sinuses from draining.

If you experience any type of headache on a recurring basis, or the pain and other symptoms make it very hard for you to carry out your regular activities of daily living, definitely contact your doctor about getting a diagnosis and starting the appropriate treatment.


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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Mar 31, 2016

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Medical References

  1. About Migraine. Migraine Research Foundation. http://www.migraineresearchfoundation.org/print-friendly/about-migraine.html
  2. Cluster headache. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/cluster-headache/basics/definition/con-20031706
  3. Headaches – tension. Penn State Hershey. http://pennstatehershey.adam.com/content.aspx?productId=10&pid=10&gid=000011
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  5. Migraine. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/definition/con-20026358
  6. Migraine fact sheet. Office on Women’s Health. U.S. Department of Health and Human Services. http://womenshealth.gov/publications/our-publications/fact-sheet/migraine.html
  7. NINDS Migraine Information Page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/migraine/migraine.htm
  8. Sinus headache. University of Maryland Medical Center. http://umm.edu/health/medical/altmed/condition/sinus-headache
  9. Tension Headache. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/tension-headache/basics/definition/con-20014295
  10. Tension Type Headache: Diagnosis and Management. American Headache Society. http://www.achenet.org/resources/tension_type_headache_diagnosis_and_management/

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