Headache or migraine: understanding the key differences

Causes and triggers

While tension headache and migraine share some similarities, including head pain, they are distinctly different conditions with unique characterizations.

Tension headache causes and triggers

There are over 150 types of headache recognized in the International Classification of Headache Disorders (ICHD-3). Tension-type headache is the most common, and can be experienced as infrequent, frequent, or chronic episodes.

Tension-type headache, also referred to as tension headache or TTH, is typically characterized by mild to moderate pain with the feeling of pressure on the sides and back of the head.

The exact reason why some people get tension-type headaches is unknown, but research suggests that genetics, brain signals, and muscle tenderness can play roles in the development.

Stress can cause muscles in the neck, face, scalp, or jaw to contract, or tense up, leading to headache, as the name “tension-type headache” suggests.

However, headache is not always caused by tension or stress and may also result from preexisting conditions like:

• Musculoskeletal problems in the neck area
• Mood disorders like bipolar disorder and depression
• Anxiety disorders
• Impulse-control disorders like ADHD
• Post-traumatic stress disorder (PTSD)
• Sleep apnea
• Insomnia
• Temporomandibular disorder (TMD)

Other lifestyle-related factors that can trigger tension-type headache, in alphabetical order, include:

• Alcohol use
• Body postures that strain the head or neck
• Dehydration
• Eyestrain
• Lack of sleep, or poor-quality sleep
• Mental strain
• Prolonged screen time
• Sunlight exposure

These lists are not exhaustive of every possible headache trigger. Consult with your healthcare provider if you have questions about a lifestyle factor or preexisting condition that could be contributing to a headache disorder.

Headache symptoms

Typical headaches, especially tension headaches, generally are perceived as mild-to-moderate, dull, consistent pain or pressure affecting both sides of the head. People commonly describe this sensation as a tight band wrapped around the forehead, or a steady ache around the temples and neck.

Usually, these headaches do not significantly interfere with daily activities, and are not accompanied by symptoms like nausea, vomiting, or sensitivity to sensory stimuli like sights, sounds, and smells. People who have tension-type headache may be sensitive to light or sound, but not both. Also, headache typically do not worsen with regular physical activities like walking or climbing stairs.

Migraine symptoms

Migraine symptoms are notably more severe and often debilitating. The pain typically presents as throbbing or pulsing, usually on one side of the head, though it can occasionally affect both sides. Migraine attacks can cause severe pain that disrupts daily routines, work, and social activities.

Additional symptoms can include nausea, vomiting, and heightened sensitivity to lights, sounds, and smells. Unlike a headache, a migraine attack frequently intensifies with routine physical activity.

A distinct characteristic of a migraine attack is the "aura," a phenomenon experienced by about a third of individuals before or during a migraine episode. Auras may include visual disturbances like flashing lights, zigzag lines, blind spots, or sensory disturbances such as tingling sensations or numbness in parts of the body.

Headache duration and frequency

Tension headaches generally last from approximately 30 minutes up to a week.

Their frequency varies significantly depending on an individual's exposure to triggers like stress, dehydration, or muscle tension, among others.